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

Yanxia Shi,Yonghong Li,Jun Wang,Lijuan Jiang,Zhenyu Yang,Yanjun Wang,Yijun Zhang,Fangjian Zhou,Liru He,Dong Chen,Zhiming Wu,Hao Zeng,Yuchao Ni,Diwei Zhao

doi:10.1186/s12885-021-08670-2

Abstract

BackgroundTo 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).MethodsPatients 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.ResultsOne 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.ConclusionsA 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.

Highlights

To assess the efficacies and potential predictors of a corticosteroid switch in metastatic castrationresistant prostate cancer patients with biochemical progression on abiraterone acetate plus prednisone (A + P)
Their study showed a prostate-specific antigen (PSA) decline of ≥50% (PSA50) in 51% of patients, whereas a PSA decline of ≥50% (PSA50) rate of 43% was observed in another trial with 5 mg P twice daily [10]
Therein, a median radiographic progression-free survival (PFS) of 26.6 and 18.5 months were observed in patients treated with D and P, respectively

Summary

Introduction

To assess the efficacies and potential predictors of a corticosteroid switch in metastatic castrationresistant prostate cancer (mCRPC) patients with biochemical progression on abiraterone acetate plus prednisone (A + P). Several studies have reported that the switch from P to D in mCRPC would achieve secondary responses [12,13,14,15,16,17,18]. These studies reported PFS of 2.5–11.8 months and PSA50 in 11–55% of patients. Previous studies with a relatively small cohort (≤ 48 cases) did not distinguish candidates who may have OS benefits from a corticosteroid switch [12,13,14,15,16,17,18]

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