Steroid Switch

[GrahamB]

I have been on Zytiga + Prednisone for approx 2 years and have had success with this treatment. In the last couple of months my PSA has risen indicating the treatment is no longer working. My Oncologist has switched the steroid from Prednisone to Dexamethasone, this has had success in trials overseas. My next PSA is around 16 Dec so fingers crossed.

I'm wondering if any member has had a similar experience with their treatment and whether they would like to share. 

GrahamB

[Charles (Chuck) Maack]

Reasonable switch in view of this:

 

Dexamethasone at a single 0.5mg per day may be an improved fit replacing prednisone/prednisolone b.i.d. at 5mg to accompany Zytiga/abiraterone.  Below study determined a reduction in PSA with the switch for patients whose PSA was showing elevation while on Zytiga/prednisolone.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425392/

 

“In conclusion, dexamethasone may be a better partner for abiraterone compared with prednisolone. Upfront use of dexamethasone with abiraterone or a switch from prednisolone to dexamethasone at PSA progression might be feasible options and are currently being tested in larger trials (ClinicalTrials.gov ID NCT01867710, Abiraterone With Different Steroid Regimens for Side Effect Related to Mineralcorticoid Excess Prevention in Prostate Cancer Prior to Chemotherapy).”

 

I have contacted my Medical Oncologist to consider the switch as well.

[Paul Edwards]

Eminent American oncologist , Dr Stephen Strum, said on his wiki in a post dated 4 July 2014:

 

"Regarding abiraterone acetate, the dose is 1000mg at one time per day (250mg tabs x 4) and prednisone is usually given as 5mg twice a day.  I have always been worried about the use of prednisone in treating men with PC since prednisone can stimulate the AR (androgen receptor) and favour PC growth.  The only steroid compound similar to predisnone that does NOT do this is called triamcinolone."

 

Strum has uploaded a research paper in support of this to the wiki.

[Admin]

Graham

Just came across this:

Br J Cancer. 2014 Dec 9;111(12):2248-53. doi: 10.1038/bjc.2014.531. Epub 2014 Oct 14.

Tumour responses following a steroid switch from prednisone to dexamethasone in castration-resistant prostate cancer patients progressing on abiraterone.

Lorente D1, Omlin A2, Ferraldeschi R1, Pezaro C1, Perez R1, Mateo J1, Altavilla A1, Zafeirou Z1, Tunariu N1, Parker C3, Dearnaley D3, Gillessen S4, de Bono J1, Attard G1.

Author information

• 1Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK.
• 21] Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK [2] Kantonsspital St. Gallen, Department of Oncology and Haematology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland.
• 3Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, Surrey, UK.
• 4Kantonsspital St. Gallen, Department of Oncology and Haematology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland.

Abstract

BACKGROUND: 

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.

METHODS: 

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.

RESULTS: 

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.

CONCLUSIONS: 

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.

PMID:   25314055   [PubMed - indexed for MEDLINE]    PMCID:   PMC4264443  [Available on 2015-12-09]  

Free full text

Free full paper:

http://www.nature.com/bjc/journal/v111/n12/full/bjc2014531a.html

 

[GrahamB]

Steroid Switch Update.

First up thanks to the respondents to my post. Yesterdays visit to the oncologist gave me a early Xmas present in that the steroid switch from prednisone to dexamethasone worked and reduced my PSA by 50% over the two month period. So the next thing is to better the 'Admin posted stats' of nil rise over 27.6wks. Fingers crossed.

GrahamB