Responders to dezamethasone identified after 1 month

[JimmyToowong]

Cancer. 2010 May 11. [Epub ahead of print]

A validated prognostic index predicting response to dexamethasone and diethylstilbestrol in castrate-resistant prostate cancer.

Shamash J, Stebbing J, Sweeney C, Sonpavde G, Harland S, Dawkins G, Brock C, Abelman W, Wilson P, Sanitt A, Oliver T, Powles T.

Department of Medical Oncology, Barts and the London National Health Service Trust, London, United Kingdom.

Abstract

BACKGROUND:: The objective of this study was to identify subgroups of patients with castrate-resistant prostate cancer (CRPC) who had a prolonged response to combined dexamethasone and diethylstilbestrol (DS) therapy by constructing a prognostic index. METHODS:: Multivariate and cutoff point analyses with bootstrapping were performed 1 month after commencing DS therapy, and data were validated using an independent external dataset.

RESULTS:: The median overall survival for 145 patients was 18.3 months (95% confidence interval [CI], 15.4-23.3 months). Only 2 factors were significant on multivariate analysis: a prostate-specific antigen (PSA) level below the median at the start of DS therapy and a decline >50% in the PSA level after 1 month on DS therapy. Subsequent cutoff point analyses revealed that a PSA level <88 ng/mL at the start of DS therapy and a reduction >53.1% in PSA after the first month of treatment were the most significant factors. These 2 factors were used to construct a prognostic index, which was validated successfully by the external dataset (median overall survival, 18.3 months [95% CI, 16.4-28.0 months]; concordance, 72% [95% CI, 68%-76%]). The prognostic index identified 3 prognostic groups: The 2-year overall survival rate for these 3 groups was 68% (95% CI, 57%-98%) for the good prognostic group, 40% (95% CI, 31%-52%) for the intermediate prognostic group, and 12% (95% CI, 5%-25%) for the poor prognostic group.

CONCLUSIONS:: The easy-to-use prognostic index that the authors developed was able to identify a subgroup of patients with CRPC who had prolonged survival only 1 month after starting DS therapy. Cancer 2010. © 2010 American Cancer Society.

PMID: 20564115 Forum: Castrate Resistant Prostate Cancer Title: Responders to dezamethasone/diethylstilbestrol identified after 1 month

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