ORIGINAL ARTICLE
Ahead of Print

Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer


1 Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
2 Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
3 Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
4 Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China

Correspondence Address:
Hao Zeng,
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041
China
Yong-Hong Li,
Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou 510060
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aja202143

PMID: 34380864

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer (mCRPC). Here, we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate (AA). We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018. All cases received AA plus prednisone as first-line therapy during mCRPC. Primary end points were biochemical progression-free survival (bPFS) and overall survival (OS). The risk groups were defined based on multivariate analysis. A total of 42 (41.6%) and 25 (24.8%) patients achieved 30% and 50% decline in prostate-specific antigen (PSA), respectively, after corticosteroid switching. The median bPFS and median OS on AA plus dexamethasone were 4.9 (95% confidence interval [CI]: 3.7–6.0) months and 18.8 (95% CI: 16.2–30.2) months, respectively. Aldo-keto reductase family 1 member C3 (AKR1C3) expression (hazard ratio [HR]: 2.15, 95% Cl: 1.22–3.80, P = 0.008) and baseline serum alkaline phosphatase (ALP; HR: 4.95, 95% Cl: 2.40–10.19, P < 0.001) were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS. Only baseline serum ALP >160 IU l−1 (HR: 3.41, 95% Cl: 1.57–7.38, P = 0.002) together with PSA level at switch ≥50 ng ml−1 (HR: 2.59, 95% Cl: 1.22–5.47, P = 0.013) independently predicted poorer OS. Based on the predictive factors in multivariate analysis, we developed two risk stratification tools to select candidates for corticosteroid switching. Detection of serum ALP level, PSA level, and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.


[FULL TEXT] [PDF]
Print this article
Search
 Back
 
  Search Pubmed for
 
    -  Ni YC
    -  Zhao JG
    -  Zhang MN
    -  Zhang YJ
    -  Yang ZY
    -  Chen N
    -  Chen JR
    -  Shen PF
    -  Sun GX
    -  Zhang XM
    -  Li YH
    -  Zeng H
 Citation Manager
 Article Access Statistics
 Reader Comments
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed897    
    PDF Downloaded74    
    Cited by others 1    

Recommend this journal