Corticosteroid switch from prednisone to dexamethasone in metastatic castration-resistant prostate cancer patients with biochemical progression on abiraterone acetate plus prednisone

Abstract

Background To assess the efficacies and potential predictors of a corticosteroid switch in metastatic castration-resistant prostate cancer (mCRPC) patients with biochemical progression on abiraterone acetate plus prednisone (A + P). Methods Patients with mCRPC treated between April 2016 and August 2020, who experienced biochemical progression on A + P and then switched to A plus dexamethasone (D), were retrospectively identified. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were PSA response, overall survival (OS), and safety. Results One hundred and thirty consecutive cases were enrolled. The median PFS and OS on A + D were 5.0 and 18.7 months, respectively. The best PSA decline of ≥50% (PSA50) and ≥ 30% (PSA30) were observed in 29.2 and 46.2% patients, respectively. Lower PSA at corticosteroid switch (≤ 20 ng/mL; median PFS, HR 0.63, p = 0.019; median OS, HR 0.38, p = 0.001) and longer mCRPC-free survival (≥ 18 months; median PFS, HR 0.61, p = 0.013; median OS, HR 0.51, p = 0.015) were identified as independent prognostic predictors associated with longer PFS and OS. A risk stratification tool was developed to select candidates for corticosteroid switch based on the independent prognostic predictors of PFS and OS. Conclusions A corticosteroid switch from prednisone to dexamethasone is effective for mCRPC which progressed on A + P treatment. Patients with lower PSA at corticosteroid switch and/or longer mCRPC-free survival may gain more benefits by the corticosteroid switch.

Phase 1 Study to Evaluate the Safety of Reducing the Prophylactic Dose of Dexamethasone around Docetaxel Infusion in Patients with Prostate and Breast Cancer

“…Nevertheless, recent clinical trials have demonstrated the benefit of using prednisone, instead of dexamethasone, in conjunction with docetaxel for the treatment of advanced prostate cancer [ 45 ]. Furthermore, Tanaka et al showed that docetaxel combined with 0.5 mg of dexamethasone orally twice a day results in a PSA response and good survival efficacy in castration-resistant prostate cancer [ 46 , 47 ], whereas other trials in patients with metastatic castration-resistant prostate cancer displayed benefits regarding switching corticosteroid from prednisone to dexamethasone after progression in abiraterone acetate [ 48 , 49 ]. This implies that particular patients with advanced prostate cancer might benefit from the use of corticosteroids.…”

Enzalutamide versus Abiraterone Plus Prednisolone for Nonmetastatic Castration-Resistant Prostate Cancer: A Sub-Analysis from the ENABLE Study for PCa

“…The unique feature of systemic post-treatment after the study treatments in the ABI arm involved more frequent use of dexamethasone and ethinylestradiol. These drugs were reported to improve some outcomes in prostate cancer patients [26][27][28][29]. Dexamethasone was used for 0 and 3 patients in the ENZ and ABI arms, respectively, and ethinylestradiol was used for 2 and 5 patients in the ENZ and ABI arms, respectively.…”

A new method to quantify the effect of co-medication on the efficacy of abiraterone in metastatic castration-resistant prostate cancer patients

“…AA+prednisolone was administered according to the treatment protocol including 1,000 mg AA and 10 mg Frontiers in Pharmacology frontiersin.org prednisolone daily. The prednisolone can be changed to 0.5 mg dexamethasone when serum level of PSA increased and no other progression was present (Yang et al, 2021). A few patients to whom dexamethasone was administered before the AA treatment (Venkitaraman et al, 2008) started with the AA+dexamethasone combination (Attard et al, 2019).…”

“…The overall survival was also investigated. During AA treatment, patients also receive a corticosteroid, typically prednisone/prednisolone or dexamethasone ( Yang et al, 2021 ). Therefore, two separate groups treated with AA were studied: those who received only prednisolone, and those who received dexamethasone.…”