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To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone

The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a ‘steroid switch’ from prednisone to dexamethasone. A total of 26 patients, both chemonaïve (14 patien...

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Autores principales: Zanardi, Elisa, Soldato, Davide, Latocca, Maria Maddalena, Cattrini, Carlo, Boccardo, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560791/
https://www.ncbi.nlm.nih.gov/pubmed/31217821
http://dx.doi.org/10.1177/1756287219854908
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author Zanardi, Elisa
Soldato, Davide
Latocca, Maria Maddalena
Cattrini, Carlo
Boccardo, Francesco
author_facet Zanardi, Elisa
Soldato, Davide
Latocca, Maria Maddalena
Cattrini, Carlo
Boccardo, Francesco
author_sort Zanardi, Elisa
collection PubMed
description The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a ‘steroid switch’ from prednisone to dexamethasone. A total of 26 patients, both chemonaïve (14 patients) or pretreated with docetaxel (12 patients), with biochemical and/or limited radiological progression, were enrolled in this trial. Primary endpoint was prostate specific antigen (PSA) 30 defined as the proportion of patients with a PSA level decline 30% or more after 6 weeks of treatment with abiraterone acetate + dexamethasone. Secondary endpoints were: a PSA50 rate (defined as the proportion of patients with PSA decline of 50% or more after 12 weeks on abiraterone acetate + dexamethasone), biochemical and radiological progression-free survival (bPFS and rPFS, respectively), benefit from subsequent treatment and identification of biomarkers of response. Primary endpoint was reached in 46.2% of patients (12 patients), and two patients had an objective partial response on computed tomography scan. Median bPFS and rPFS were 5.3 months and 11.8 months. We present a case series of 11 patients who were consecutively treated with a steroid switch at our institution from January 2016 to August 2018 to investigate if this strategy could be used in a ‘real-life’ setting. We observed a PSA30 response in two patients (18%), median bPFS was 4.77 months (95% confidence interval [CI] 2.5–14.6) and median rPFS was 7.2 months (95% CI 3.8–15.5). Seven patients had a radiological stable disease as best response to steroid switch. Three patients were being still treated with abiraterone acetate + dexamethasone at data cut-off time. Our case series confirms that switching from prednisone to dexamethasone during abiraterone acetate treatment produces biochemical and radiological responses in both a predocetaxel and a postdocetaxel setting, providing a clinical benefit in mCRPC patients. However, to date, there is no clear indication as to which patient could benefit most from this kind of strategy.
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spelling pubmed-65607912019-06-19 To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone Zanardi, Elisa Soldato, Davide Latocca, Maria Maddalena Cattrini, Carlo Boccardo, Francesco Ther Adv Urol Case Series The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a ‘steroid switch’ from prednisone to dexamethasone. A total of 26 patients, both chemonaïve (14 patients) or pretreated with docetaxel (12 patients), with biochemical and/or limited radiological progression, were enrolled in this trial. Primary endpoint was prostate specific antigen (PSA) 30 defined as the proportion of patients with a PSA level decline 30% or more after 6 weeks of treatment with abiraterone acetate + dexamethasone. Secondary endpoints were: a PSA50 rate (defined as the proportion of patients with PSA decline of 50% or more after 12 weeks on abiraterone acetate + dexamethasone), biochemical and radiological progression-free survival (bPFS and rPFS, respectively), benefit from subsequent treatment and identification of biomarkers of response. Primary endpoint was reached in 46.2% of patients (12 patients), and two patients had an objective partial response on computed tomography scan. Median bPFS and rPFS were 5.3 months and 11.8 months. We present a case series of 11 patients who were consecutively treated with a steroid switch at our institution from January 2016 to August 2018 to investigate if this strategy could be used in a ‘real-life’ setting. We observed a PSA30 response in two patients (18%), median bPFS was 4.77 months (95% confidence interval [CI] 2.5–14.6) and median rPFS was 7.2 months (95% CI 3.8–15.5). Seven patients had a radiological stable disease as best response to steroid switch. Three patients were being still treated with abiraterone acetate + dexamethasone at data cut-off time. Our case series confirms that switching from prednisone to dexamethasone during abiraterone acetate treatment produces biochemical and radiological responses in both a predocetaxel and a postdocetaxel setting, providing a clinical benefit in mCRPC patients. However, to date, there is no clear indication as to which patient could benefit most from this kind of strategy. SAGE Publications 2019-06-11 /pmc/articles/PMC6560791/ /pubmed/31217821 http://dx.doi.org/10.1177/1756287219854908 Text en © The Author(s), 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Series
Zanardi, Elisa
Soldato, Davide
Latocca, Maria Maddalena
Cattrini, Carlo
Boccardo, Francesco
To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title_full To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title_fullStr To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title_full_unstemmed To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title_short To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone
title_sort to switch or not to switch? a real-life experience using dexamethasone in combination with abiraterone
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560791/
https://www.ncbi.nlm.nih.gov/pubmed/31217821
http://dx.doi.org/10.1177/1756287219854908
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