Tumour responses following a steroid switch from prednisone to dexamethasone in castration-resistant prostate cancer patients progressing on abiraterone.
Tumour responses following a steroid switch from prednisone to dexamethasone in castration-resistant prostate cancer patients progressing on abiraterone.
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DOI：
10.1038/bjc.2014.531
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发表时间：
2014-12-09
影响因子：
8.8
通讯作者：
Attard, G.
中科院分区：
文献类型：
--
作者：
Lorente, D.;Omlin, A.;Ferraldeschi, R.;Pezaro, C.;Perez, R.;Mateo, J.;Altavilla, A.;Zafeirou, Z.;Tunariu, N.;Parker, C.;Dearnaley, D.;Gillessen, S.;de Bono, J.;Attard, G.
关键词：
阿比特龙是一种CYP 17 A1抑制剂，可提高去势抵抗性前列腺癌（CRPC）的生存率。阿比特龙被许可与泼尼松5 mg每日两次联合使用，以预防继发性盐皮质激素过量综合征。我们假设，阿比特龙和泼尼松5 mg b.i.d.治疗进展的患者中，从泼尼松到地塞米松的“类固醇转换”将诱导继发性反应。我们在PSA进展的CRPC患者中对阿比特龙和泼尼松龙进行了“类固醇转换”。监测患者的PSA继发性下降、放射学肿瘤消退和毒性。对30例在阿比特龙治疗期间从泼尼松龙转换为地塞米松的CRPC患者进行了回顾性分析。共有6名患者（20%）PSA下降> 50%，至少3周后通过第二次PSA水平确认。共有11例患者（39.2%）证实PSA下降≥ 30%。在整个队列中，阿比特龙和地塞米松治疗后至PSA进展的中位时间为11.7周（95% CI：8.6-14.8周），在确认PSA下降50%的患者中为27.6周（95% CI：14.5-40.7周）。9例患者具有RECIST可评价疾病：其中2例患者具有RECIST部分缓解，6例患者具有稳定疾病，1例患者在首次成像评估时具有疾病进展。治疗耐受性良好，无3级和4级不良事件。1例患者因2级低血压而恢复泼尼松龙治疗。高达40%的患者在阿比特龙和泼尼松治疗PSA进展的“类固醇转换”后发生持久的PSA应答。目前正在进行研究，以阐明这种反应的机制。
Abiraterone is a CYP17A1 inhibitor that improves survival in castration-resistant prostate cancer (CRPC). Abiraterone is licensed in combination with prednisone 5 mg 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 5 mg b.i.d. 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. 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. 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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影响因子：
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作者：
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通讯作者：
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影响因子：
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45.3
作者：
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通讯作者：
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DOI：
10.1200/jco.2008.20.0642
发表时间：
2009-08-10
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Attard G;Reid AH;A'Hern R;Parker C;Oommen NB;Folkerd E;Messiou C;Molife LR;Maier G;Thompson E;Olmos D;Sinha R;Lee G;Dowsett M;Kaye SB;Dearnaley D;Kheoh T;Molina A;de Bono JS
通讯作者：
de Bono JS