Phase II pilot study of the prednisone to dexamethasone switch in metastatic castration-resistant prostate cancer (mCRPC) patients with limited progression on abiraterone plus prednisone (SWITCH study)

Abstract

In selected clinical stable mCRPC patients with limited disease progression on AA + P, a steroid switch from prednisone to dexamethasone can lead to PSA and radiological responses.

Replacing prednisolone with dexamethasone to overcome the resistance to abiraterone in castration-resistant prostate cancer: a clinical case

“…Исследование II фазы SWITCH -первый проспективный протокол, оценивающий замену комбинации АА + преднизолон на комбинацию АА + дексаметазон. В него были включены 26 пациентов [10]. Исследование интересно также тем, что в него вошли как получавшие, так и не получавшие химиотерапию пациенты.…”

“…Последний анализ подобного подхода был опубликован в 2019 г. E. Zanardi [9] D. Lorente et al, 2014 [9] Пациенты с изолированным биохимическим прогрессированием Patients with isolated biochemical progression N. Romero-Laorden и соавт., 2018 [10] N. Romero-Laorden et al, 2018 [10] Клинически стабильные пациенты Clinically stable patients G. Roviello и соавт., 2018 [11] G. Roviello et al, 2018 [11] Пациенты, получавшие терапию комбинацией абиратерона ацетат + преднизолон >3 мес…”

A Canadian framework for managing prostate cancer during the COVID-19 pandemic: Recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association

“…6. For patients receiving and progressing on abiraterone, the switch from prednisone to dexamethasone is commonly practiced and may delay the time to initiation of chemotherapy 36 . This may be advantageous in the setting of COVID-19.…”

Lessons from the SWITCH trial: changing glucocorticoids in the management of metastatic castration-resistant prostate cancer (mCRPC)

“…In this issue, Romero-Laorden and colleagues report on the phase II SWITCH trial, in which patients with mCRPC who were progressing on A + P (5 mg twice daily) responded when prednisone was stopped and dexamethasone (0.5 mg daily) was started: a glucocorticoid switch. 1 The rationale was based on a retrospective evaluation of 30 mCRPC patients treated with A + P who received dexamethasone upon progression, in which ≥30% declines in PSA that persisted for a median of 20.6 weeks were observed. 2 Enrolment on the SWITCH trial was limited to patients with PSA progression alone or PSA progression with ‘modest’ changes in imaging, defined as three or fewer new asymptomatic lesions on bone scan, absence of new soft-tissue disease and a <40% increase in the size of pre-existing target lesions per RECIST 1.1 criteria.…”

“…2 Enrolment on the SWITCH trial was limited to patients with PSA progression alone or PSA progression with ‘modest’ changes in imaging, defined as three or fewer new asymptomatic lesions on bone scan, absence of new soft-tissue disease and a <40% increase in the size of pre-existing target lesions per RECIST 1.1 criteria. 1 Overall, 26 patients were enrolled, 14 of whom (53.8%) were docetaxel-naïve and 12 (46.2%) had radiographic evidence of progression. Consistent with the prior observations, a ≥30% fall in PSA that was maintained for ≥6 weeks was observed in 12 (46.2%) cases and a ≥50% fall in PSA for ≥12 weeks in eight (34.6%) cases following the switch to dexamethasone.…”