期刊
BRITISH JOURNAL OF CANCER
卷 111, 期 12, 页码 2248-2253出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/bjc.2014.531
关键词
castration-resistant prostate cancer; prednisolone; glucocorticoid receptor; steroid switch; abiraterone; hormone therapy; dexamethasone; androgen receptor
类别
资金
- Spanish Society of Medical Oncology - 'Beca SEOM Para la Investigacion Traslacional en el Extranjero'
- Swiss Cancer League [BIL KLS-02592-02-2010]
- Wellcome Trust
- Hellenic Society of Medical Oncology
- Cancer Research UK
- Prostate Cancer UK
- Prostate Cancer Foundation
- Cancer Research UK [13239, 10588] Funding Source: researchfish
- National Institute for Health Research [CL-2008-22-001] Funding Source: researchfish
- Prostate Cancer UK [PG12-49] Funding Source: researchfish
Background: Abiraterone is a CYP17A1 inhibitor that improves survival in castration-resistant prostate cancer (CRPC). Abiraterone is licensed in combination with prednisone 5mg twice daily to prevent a syndrome of secondary mineralocorticoid excess. We hypothesised that a 'steroid switch' from prednisone to dexamethasone would induce secondary responses in patients progressing on abiraterone and prednisone 5mg b.i.d. Methods: We performed a 'steroid switch' in patients with CRPC at PSA progression on abiraterone and prednisolone. Patients were monitored for secondary declines in PSA, radiological tumour regression and toxicity. Results: A retrospective analysis of 30 CRPC patients who underwent a steroid switch from prednisolone to dexamethasone while on abiraterone was performed. A total of six patients (20%) had a >= 50% PSA decline that was confirmed by a second PSA level at least 3 weeks later. In all, 11 patients (39.2%) had a confirmed >= 30% PSA decline. Median time to PSA progression on abiraterone and dexamethasone was 11.7 weeks (95% CI: 8.6-14.8 weeks) in the whole cohort and 27.6 weeks (95% CI: 14.5-40.7 weeks) in patients who achieved a confirmed 50% PSA decline. Nine patients had RECIST evaluable disease: two of these patients had RECIST partial response, six patients had stable disease and one patient had progressive disease at the first imaging assessment. Treatment was well tolerated, with no grade 3 and grade 4 adverse events. One patient had to be reverted to prednisolone because of grade 2 hypotension. Conclusions: Durable PSA responses occur in up to 40% of patients following a 'steroid switch' for PSA progression on abiraterone and prednisone. Studies are ongoing to elucidate the mechanisms underlying this response.
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