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Abusamra A, Murshid E, Kushi H, Alkhateeb S, Al-Mansour M, Saadeddin A, Rabah D, Bazarbashi S, Alotaibi M, Alghamdi A, Alghamdi K, Alsharm A, Ahmad I. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2016; 8:123-130. [PMID: 27141178 PMCID: PMC4839225 DOI: 10.4103/0974-7796.176872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.
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Affiliation(s)
- Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Hussain Kushi
- Department of Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Li J, Li H, Zhang Z, Wang N, Zhang Y. The anti-cancerous activity of recombinant trichosanthin on prostate cancer cell PC3. Biol Res 2016; 49:21. [PMID: 27015938 PMCID: PMC4807558 DOI: 10.1186/s40659-016-0081-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/18/2016] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Trichosanthin produced in the root tube of Trichosanthes kirilowii shows anti-tumor activity on a series of cancer cells including Hela, MCF-7, HL-60. But there is little information about its effect on the carcinogenesis of prostate cancer. OBJECTIVE This work was designed to study the role of trichosanthin on prostate cancer cells PC3. MATERIALS AND METHODS Trichosanthin was expressed in BL21 strain and purified by affinity chromatography. MTT assay was designed to determine the effect of trichosanthin on growth of PC3 cells at doses of 10, 20, 40, 60, 80, and 120 μg/ml. Then the effect of 50 μg/ml rTCS alone or combined with 2 μM IL-2 on PC3 cell proliferation was analyzed. And the mechanism of rTCS was studied by western blot. After that the in vivo effect of rTCS combined with IL-2 was explored in mice bearing PC3 xenograft tumor. RESULTS Trichosanthin was successfully expressed in BL21 and purified by 100 mM imidazole. It was shown to inhibit proliferation of PC3 cells in a dose-dependent manner with IC50 50.6 μg/ml. When combined with cytokine IL-2, a significant synergic effect was obtained. The inhibition rate on PC3 was around 50 % in combination group while only 35.5 % in single rTCS group at 50 μg/ml. Further, the expression of full length caspase-8 and Bcl-2 decreased significantly while cleaved caspase-8 and Bax were up-regulated, which suggest that caspase-8-mediated apoptosis pathway may be activated by rTCS in PC3 cells. Moreover, our data demonstrated that tumor volume and tumor weight were significantly reduced in rTCS-treated or rTCS/IL-2-treated nude mice bearing PC3 xenograft tumor compared with control. And significant difference was also found between rTCS and rTCS/IL-2 group. CONCLUSIONS This study demonstrates that rTCS is a potential agent with high in vitro and in vivo anti-tumor activity on PC3 cells. And rTCS combined with IL-2 is a promising strategy in treating patients with prostate cancer in future.
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Affiliation(s)
- JinLong Li
- />Department of Laboratory Medicine, The Second Affiliated Hospital of Southeast University, Zhongfu Road 1-1, Nanjing, 210003 China
- />Department of Biochemistry and State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, 210093 China
| | - Hui Li
- />Department of Neonatology, The Taizhou People’s Hospital, Taizhou, 225300 China
| | - ZhaoLi Zhang
- />Department of Pharmacy, The Second Affiliated Hospital of Southeast University, Nanjing, 210003 China
| | - NianYue Wang
- />Department of Laboratory Medicine, The Second Affiliated Hospital of Southeast University, Zhongfu Road 1-1, Nanjing, 210003 China
| | - YongChen Zhang
- />Department of Laboratory Medicine, The Second Affiliated Hospital of Southeast University, Zhongfu Road 1-1, Nanjing, 210003 China
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Abstract
Much progress has been made in research for prostate cancer in the past decade. There is now greater understanding for the genetic basis of familial prostate cancer with identification of rare but high-risk mutations (eg, BRCA2, HOXB13) and low-risk but common alleles (77 identified so far by genome-wide association studies) that could lead to targeted screening of patients at risk. This is especially important because screening for prostate cancer based on prostate-specific antigen remains controversial due to the high rate of overdiagnosis and unnecessary prostate biopsies, despite evidence that it reduces mortality. Classification of prostate cancer into distinct molecular subtypes, including mutually exclusive ETS-gene-fusion-positive and SPINK1-overexpressing, CHD1-loss cancers, could allow stratification of patients for different management strategies. Presently, men with localised disease can have very different prognoses and treatment options, ranging from observation alone through to radical surgery, with few good-quality randomised trials to inform on the best approach for an individual patient. The survival of patients with metastatic prostate cancer progressing on androgen-deprivation therapy (castration-resistant prostate cancer) has improved substantially. In addition to docetaxel, which has been used for more than a decade, in the past 4 years five new drugs have shown efficacy with improvements in overall survival leading to licensing for the treatment of metastatic castration-resistant prostate cancer. Because of this rapid change in the therapeutic landscape, no robust data exist to inform on the selection of patients for a specific treatment for castration-resistant prostate cancer or the best sequence of administration. Moreover, the high cost of the newer drugs limits their widespread use in several countries. Data from continuing clinical and translational research are urgently needed to improve, and, crucially, to personalise management.
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Affiliation(s)
- Gerhardt Attard
- Division of Clinical Studies, The Institute of Cancer Research, London, UK; Prostate Cancer Targeted Therapy Group, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Chris Parker
- Academic Urology Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Ros A Eeles
- Clinical Academic Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Oncogenetics Team, Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Fritz Schröder
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Scott A Tomlins
- Departments of Pathology Urology, Comprehensive Cancer Center and Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ian Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Charles G Drake
- Division of Medical Oncology, Johns Hopkins Hospital, Baltimore, MA, USA
| | - Johann S de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, UK; Prostate Cancer Targeted Therapy Group, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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Lorente D, Mateo J, Zafeiriou Z, Smith AD, Sandhu S, Ferraldeschi R, de Bono JS. Switching and withdrawing hormonal agents for castration-resistant prostate cancer. Nat Rev Urol 2015; 12:37-47. [PMID: 25563847 DOI: 10.1038/nrurol.2014.345] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The antiandrogen withdrawal syndrome (AAWS) is characterized by tumour regression and a decline in serum PSA on discontinuation of antiandrogen therapy in patients with prostate cancer. This phenomenon has been best described with the withdrawal of the nonsteroidal antiandrogens, bicalutamide and flutamide, but has also been reported with a wide range of hormonal agents. Mutations that occur in advanced prostate cancer and induce partial activation of the androgen receptor (AR) by hormonal agents have been suggested as the main causal mechanism of the AAWS. Corticosteroids, used singly or in conjunction with abiraterone, docetaxel and cabazitaxel might also be associated with the AAWS. The discovery of the Phe876Leu mutation in the AR, which is activated by enzalutamide, raises the possibility of withdrawal responses to novel hormonal agents. This Review focusses on the molecular mechanisms responsible for withdrawal responses, the role of AR mutations in the development of treatment resistance, and the evidence for the sequential use of antiandrogens in prostate cancer therapy. The implications of AR mutations for the development of novel drugs that target the AR are discussed, as are the challenges associated with redefining the utility of older treatments in the current therapeutic landscape.
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Affiliation(s)
- David Lorente
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Joaquin Mateo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Zafeiris Zafeiriou
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Alan D Smith
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Shahneen Sandhu
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Roberta Ferraldeschi
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Johann S de Bono
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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Massari F, Modena A, Ciccarese C, Pilotto S, Maines F, Bracarda S, Sperduti I, Giannarelli D, Carlini P, Santini D, Tortora G, Porta C, Bria E. Addressing the expected survival benefit for clinical trial design in metastatic castration-resistant prostate cancer: Sensitivity analysis of randomized trials. Crit Rev Oncol Hematol 2015; 98:254-63. [PMID: 26638863 DOI: 10.1016/j.critrevonc.2015.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/25/2015] [Accepted: 11/12/2015] [Indexed: 11/28/2022] Open
Abstract
We performed a sensitivity analysis, cumulating all randomized clinical trials (RCTs) in which patients with metastatic castration-resistant prostate cancer (mCRPC) received systemic therapy, to evaluate if the comparison of RCTs may drive to biased survival estimations. An overall survival (OS) significant difference according to therapeutic strategy was more likely be determined in RCTs evaluating hormonal drugs versus those studies testing immunotherapy, chemotherapy or other strategies. With regard to control arm, an OS significant effect was found for placebo-controlled trials versus studies comparing experimental treatment with active therapies. Finally, regarding to docetaxel (DOC) timing, the OS benefit was more likely to be proved in Post-DOC setting in comparison with DOC and Pre-DOC. These data suggest that clinical trial design should take into account new benchmarks such as the type of treatment strategy, the choice of the comparator and the phase of the disease in relation to the administration of standard chemotherapy.
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Affiliation(s)
- Francesco Massari
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Alessandra Modena
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Chiara Ciccarese
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Sara Pilotto
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | | | - Sergio Bracarda
- Medical Oncology, Ospedale San Donato, Istituto Toscano Tumori, Arezzo, Italy.
| | | | | | - Paolo Carlini
- Medical Oncology, Regina Elena National Cancer Institute, Roma, Italy.
| | - Daniele Santini
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Roma, Italy.
| | - Giampaolo Tortora
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Camillo Porta
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Rawal S. Management of locally advanced prostate cancer before the era of abiraterone/enzalutamide: A case study from India. Prostate Int 2015. [DOI: 10.1016/j.prnil.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Saad F, Fizazi K. Androgen Deprivation Therapy and Secondary Hormone Therapy in the Management of Hormone-sensitive and Castration-resistant Prostate Cancer. Urology 2015; 86:852-61. [DOI: 10.1016/j.urology.2015.07.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 01/08/2023]
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Okonogi N, Katoh H, Kawamura H, Tamaki T, Kaminuma T, Murata K, Ohkubo Y, Takakusagi Y, Onishi M, Sekihara T, Okazaki A, Nakano T. Clinical outcomes of helical tomotherapy for super-elderly patients with localized and locally advanced prostate cancer: comparison with patients under 80 years of age. JOURNAL OF RADIATION RESEARCH 2015; 56:889-96. [PMID: 26320208 PMCID: PMC4628216 DOI: 10.1093/jrr/rrv040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/06/2015] [Accepted: 06/18/2015] [Indexed: 06/01/2023]
Abstract
We investigated the clinical outcomes of helical tomotherapy in 23 patients aged ≥80 years with localized and locally advanced prostate cancer and compared the results with data from 171 patients under 80 years. All patients received helical tomotherapy in our hospital between September 2009 and October 2012. The median follow-up periods were 35 months in the aged group and 34 months in the younger group. The median prescribed dose in helical tomotherapy was 78 Gy in 39 fractions (range, 72-78 Gy). The 3-year overall survival and biochemical relapse-free rates were 92% and 96% in the aged group and 99.4% and 97.3% in the younger group, respectively. There was no significant difference between the two groups in the biochemical relapse-free rates. The 3-year cumulative incidences of late Grade 2 or higher rectal toxicity and urinary toxicity were 13% and 4.8% in the aged group and 7.0% and 1.2% in the younger group, respectively. There was no significant difference between the aged group and the younger group in the cumulative incidence rates of rectal toxicity or urinary toxicity. No patients exhibited Grade 4 or higher toxicity, and all patients improved with conservative therapy. Helical tomotherapy in super-elderly patients with localized and locally advanced prostate cancer had good biochemical control rates without severe late toxicity. Definitive helical tomotherapy may be the treatment of choice for patients with localized and locally advanced prostate cancer, even in those older than 80 years of age.
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Affiliation(s)
- Noriyuki Okonogi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan Oncology Center, Hidaka Hospital, 886, Nakao-machi, Takasaki, Gunma 370-0001, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yu Ohkubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yosuke Takakusagi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Masahiro Onishi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tetsuo Sekihara
- Department of Urology, Hidaka Hospital, 886, Nakao-machi, Takasaki, Gunma 370-0001, Japan
| | - Atsushi Okazaki
- Oncology Center, Hidaka Hospital, 886, Nakao-machi, Takasaki, Gunma 370-0001, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
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Schroeder RL, Tram P, Liu J, Foroozesh M, Sridhar J. Novel functionalized 5-(phenoxymethyl)-1,3-dioxane analogs exhibiting cytochrome P450 inhibition: a patent evaluation WO2015048311 (A1). Expert Opin Ther Pat 2015; 26:139-47. [PMID: 26514241 DOI: 10.1517/13543776.2016.1105217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cytochrome P450's (CYP's) constitute a diverse group of over 500 monooxygenase hemoproteins, catalyzing transformations that involve xenobiotic metabolism, steroidogenesis and other metabolic processes. Over-production of the steroid hormone cortisol is implicated in the progression of diseases such as diabetes, heart failure and hypertension, stroke, Cushing's syndrome, obesity and renal failure, among others. The biosynthesis of cortisol involves a cascade of cholesterol metabolizing reactions regulated through three major CYP proteins: 17α-hydroxylase-C17/20-lyase (CYP17), 21-hydroxylase (CYP21), and 11β-hydroxylase (CYP11B1). Excess activities of these enzymes are linked to the progression of malignancies including prostate, breast, ovarian, and uterine cancers. A series of novel functionalized dioxane analogs have been developed and recently patented as CYP17, CYP21, and CYP11B1 inhibitors, which lead to the modulation of cortisol production as a method for treating, delaying, slowing, and inhibiting the implicated diseases. The findings disclosed in this patent have been analyzed and compared with the literature data on inhibitors of CYP17, CYP21, and CYP11B1. The compiled data provide insight into the novel functionality of the compounds described in the patent. In this regard, an objective opinion on the effectiveness and novel biochemistry of these compounds in comparison to current CYP inhibitors used in the treatment of cortisol-related diseases is presented in this paper.
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Affiliation(s)
- Richard L Schroeder
- a Department of Chemistry , Xavier University of Louisiana , New Orleans , LA , USA
| | - Phan Tram
- a Department of Chemistry , Xavier University of Louisiana , New Orleans , LA , USA
| | - Jiawang Liu
- a Department of Chemistry , Xavier University of Louisiana , New Orleans , LA , USA
| | - Maryam Foroozesh
- a Department of Chemistry , Xavier University of Louisiana , New Orleans , LA , USA
| | - Jayalakshmi Sridhar
- a Department of Chemistry , Xavier University of Louisiana , New Orleans , LA , USA
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Hanyok BT, Howard LE, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Terris MK, Posadas EM, Freedland SJ. Is computed tomography a necessary part of a metastatic evaluation for castration-resistant prostate cancer? Results from the Shared Equal Access Regional Cancer Hospital Database. Cancer 2015; 122:222-9. [DOI: 10.1002/cncr.29748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Brian T. Hanyok
- Urology Section, Veterans Affairs Medical Center; Durham North Carolina
| | - Lauren E. Howard
- Urology Section, Veterans Affairs Medical Center; Durham North Carolina
- Department of Biostatistics and Bioinformatics; Duke University School of Medicine; Durham North Carolina
| | - Christopher L. Amling
- Division of Urology, Department of Surgery; Oregon Health and Science University; Portland Oregon
| | - William J. Aronson
- Urology Section, Department of Surgery; Veterans Affairs Medical Center of Greater Los Angeles; Los Angeles California
- Department of Urology; University of California Los Angeles Medical Center; Los Angeles California
| | - Matthew R. Cooperberg
- Division of Urology, Department of Surgery; University of California San Francisco Medical Center; San Francisco California
| | - Christopher J. Kane
- Division of Urology, Department of Surgery; University of California San Diego Medical Center; San Diego California
| | - Martha K. Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center; Augusta Georgia
- Division of Urologic Surgery, Department of Surgery; Medical College of Georgia; Augusta Georgia
| | - Edwin M. Posadas
- Division of Hematology/Oncology, Cedars-Sinai Medical Center; Los Angeles California
| | - Stephen J. Freedland
- Urology Section, Veterans Affairs Medical Center; Durham North Carolina
- Division of Urology, Department of Surgery; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center; Los Angeles California
- Center for Integrated Research in Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center; Los Angeles California
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Gartrell BA, Saad F. Abiraterone in the management of castration-resistant prostate cancer prior to chemotherapy. Ther Adv Urol 2015; 7:194-202. [PMID: 26445599 DOI: 10.1177/1756287215592288] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The treatment armamentarium for metastatic castration-resistant prostate cancer (mCRPC) has increased significantly over the past several years. Approved drugs associated with improved survival include androgen pathway-targeted agents (abiraterone acetate and enzalutamide), chemotherapeutics (docetaxel and cabazitaxel), an autologous vaccine (sipuleucel-T) and a radiopharmaceutical (radium-223). Abiraterone acetate, a prodrug of abiraterone, inhibits the CYP17A enzyme, a critical enzyme in androgen biosynthesis. Abiraterone has regulatory approval in mCRPC in both chemotherapy-naïve patients and in the post-docetaxel setting based on results from two randomized phase III studies. In the COU-AA-302 trial, abiraterone demonstrated significant improvement in the coprimary endpoints of radiographic progression-free survival and overall survival, as well as in a number of secondary endpoints including time until initiation of chemotherapy, time until opiate use for cancer-related pain, prostate-specific antigen progression-free survival and decline in performance status. Abiraterone is well-tolerated, although adverse events associated with this agent include abnormalities in liver function testing and mineralocorticoid-associated adverse events. This review evaluates the use of abiraterone in mCRPC prior to the use of chemotherapy.
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Affiliation(s)
- Benjamin A Gartrell
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467, USA
| | - Fred Saad
- Centre Hospitalier de I'Université de Montréal, Montreal, Canada
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Conteduca V, Caffo O, Fratino L, Lo Re G, Basso U, D'Angelo A, Donini M, Verderame F, Ratta R, Procopio G, Campadelli E, Massari F, Gasparro D, Ermacora P, Messina C, Giordano M, Alesini D, Zagonel V, Veccia A, Lolli C, Maines F, De Giorgi U. Impact of visceral metastases on outcome to abiraterone after docetaxel in castration-resistant prostate cancer patients. Future Oncol 2015; 11:2881-91. [PMID: 26436290 DOI: 10.2217/fon.15.158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The objective of this study was to analyze the impact of visceral metastases in castration-resistant prostate cancer (CRPC) treated with abiraterone. MATERIALS & METHODS All CRPC patients received abiraterone 1000 mg daily plus prednisone 10 mg orally daily. Liver and lung metastases were considered as visceral metastases. RESULTS Of 265 CRPC patients, 49 had visceral metastases. Results on progression-free survival were not significantly different in patients with or without visceral metastases. Conversely, the median overall survival between the two groups was 12.4 and 18.5 months (p = 0.01), respectively, and median overall survival of patients with liver-only disease versus other sites was 10.5 versus 18.5 months (p = 0.006), respectively. CONCLUSION Visceral disease appears to be an important predictor of clinical outcome in CRPC patients treated with abiraterone.
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Affiliation(s)
- Vincenza Conteduca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | - Giovanni Lo Re
- Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | - Umberto Basso
- Medical Oncology Unit I, Department of Clinical & Experimental Oncology Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy
| | | | | | | | | | - Giuseppe Procopio
- Oncology Unit I, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Paola Ermacora
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Caterina Messina
- Medical Oncology Unit, Piazza OMS, 1, Pope John Paul XXIII Hospital, Bergamo, Italy
| | | | - Daniele Alesini
- Division of Medical Oncology, Università la Sapienza Roma, Rome, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit I, Department of Clinical & Experimental Oncology Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy
| | | | - Cristian Lolli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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van Dodewaard-de Jong JM, Verheul HM, Bloemendal HJ, de Klerk JM, Carducci MA, van den Eertwegh AJ. New Treatment Options for Patients With Metastatic Prostate Cancer: What Is The Optimal Sequence? Clin Genitourin Cancer 2015; 13:271-279. [DOI: 10.1016/j.clgc.2015.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/04/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
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Gillessen S, Omlin A, Attard G, de Bono JS, Efstathiou E, Fizazi K, Halabi S, Nelson PS, Sartor O, Smith MR, Soule HR, Akaza H, Beer TM, Beltran H, Chinnaiyan AM, Daugaard G, Davis ID, De Santis M, Drake CG, Eeles RA, Fanti S, Gleave ME, Heidenreich A, Hussain M, James ND, Lecouvet FE, Logothetis CJ, Mastris K, Nilsson S, Oh WK, Olmos D, Padhani AR, Parker C, Rubin MA, Schalken JA, Scher HI, Sella A, Shore ND, Small EJ, Sternberg CN, Suzuki H, Sweeney CJ, Tannock IF, Tombal B. Management of patients with advanced prostate cancer: recommendations of the St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) 2015. Ann Oncol 2015; 26:1589-604. [PMID: 26041764 PMCID: PMC4511225 DOI: 10.1093/annonc/mdv257] [Citation(s) in RCA: 234] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 12/18/2022] Open
Abstract
The first St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed the available evidence for the ten most important areas of controversy in advanced prostate cancer (APC) management. The successful registration of several drugs for castration-resistant prostate cancer and the recent studies of chemo-hormonal therapy in men with castration-naïve prostate cancer have led to considerable uncertainty as to the best treatment choices, sequence of treatment options and appropriate patient selection. Management recommendations based on expert opinion, and not based on a critical review of the available evidence, are presented. The various recommendations carried differing degrees of support, as reflected in the wording of the article text and in the detailed voting results recorded in supplementary Material, available at Annals of Oncology online. Detailed decisions on treatment as always will involve consideration of disease extent and location, prior treatments, host factors, patient preferences as well as logistical and economic constraints. Inclusion of men with APC in clinical trials should be encouraged.
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Affiliation(s)
- S Gillessen
- Department of Oncology/Haematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - A Omlin
- Department of Oncology/Haematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - E Efstathiou
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston Department of Genitourinary Medical Oncology, David H. Koch Centre, The University of Texas M. D. Anderson Cancer Centre, Houston, USA Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | - P S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research Centre, Seattle
| | - O Sartor
- Tulane Cancer Centre, Tulane University, New Orleans
| | - M R Smith
- Massachusetts General Hospital Cancer Centre, Boston
| | - H R Soule
- Prostate Cancer Foundation, Santa Monica, USA
| | - H Akaza
- Research Centre for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - T M Beer
- Oregon Health & Science University Knight Cancer Institute, Portland
| | - H Beltran
- Department of Medicine, Weill Cornell Medical College, New York
| | - A M Chinnaiyan
- Michigan Centre for Translational Pathology, Department of Pathology Department of Urology, Comprehensive Cancer Centre Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, USA
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - M De Santis
- Cancer Research Centre, University of Warwick, Warwick, UK Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef-Spital, Vienna, Austria
| | - C G Drake
- Johns Hopkins Sidney Kimmel Cancer Center and The Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - R A Eeles
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - M E Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - A Heidenreich
- Klinik und Poliklinik für Urologie, RWTH University Aachen, Aachen, Germany
| | - M Hussain
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - N D James
- Cancer Research Centre, University of Warwick, Warwick, UK Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - F E Lecouvet
- Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - C J Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston Department of Genitourinary Medical Oncology, David H. Koch Centre, The University of Texas M. D. Anderson Cancer Centre, Houston, USA
| | - K Mastris
- Europa Uomo Prostate Patients, Clayhall Ilford, UK
| | - S Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - W K Oh
- Division of Haematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid CNIO-IBIMA Genitourinary Cancer Unit, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood
| | - C Parker
- Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - M A Rubin
- Institute for Precision Medicine, Meyer Cancer Center, Department of Pathology and Urology, Weill Cornell Medical College and NewYork Presbyterian, New York, USA
| | - J A Schalken
- Department of Urology, Radboud University, Medical Centre, Nijmegen, The Netherlands
| | - H I Scher
- Department of Medicine, Weill Cornell Medical College, New York Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York
| | - A Sella
- Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - N D Shore
- Department of Urology, Carolina Urologic Research Centre, Myrtle Beach
| | - E J Small
- Helen Diller Family Comprehensive Cancer Centre, UCSF, San Francisco, USA
| | - C N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - H Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - C J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - I F Tannock
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - B Tombal
- Service D'Urologie, Institut de Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
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Miller K, Simson G, Goble S, Persson BE. Efficacy of degarelix in prostate cancer patients following failure on luteinizing hormone-releasing hormone agonist treatment: results from an open-label, multicentre, uncontrolled, phase II trial (CS27). Ther Adv Urol 2015; 7:105-15. [PMID: 26161141 DOI: 10.1177/1756287215574479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of second-line degarelix in patients with prostate cancer (PCa) after treatment failure with a luteinizing hormone-releasing hormone (LHRH) agonist. METHODS This 1-year exploratory, multicentre, open-label phase II trial was performed in 2 patient cohorts (Cohort 1, n = 25; Cohort 2, n = 12) in Germany. Patients with castrate-resistant PCa after primary hormonal treatment received degarelix 240 mg, followed by 11 monthly maintenance doses of 80 mg. The primary endpoint was the proportion of patients with decreasing/stable prostate-specific antigen (PSA) (relative change ⩽+10% of baseline PSA) after 3 months. RESULTS At Month 3, the response rate (intention-to-treat, last observation carried forward analysis) was 16.7% [95% confidence interval (CI): 4.74-37.38] in Cohort 1 and 33.3% (95% CI: 9.92-65.11) in Cohort 2. The probability of completing 12 months without PSA progression was 8.8% (95% CI: 1.51-24.3) in Cohort 1 and 8.3% (95% CI: 0.5-31.1) in Cohort 2. Degarelix was well tolerated; the most frequently reported adverse events were local injection-site reactions. CONCLUSIONS In PCa patients who failed LHRH therapy, degarelix was well tolerated and achieved a limited PSA response. Phase III trials show that disease control benefits with degarelix versus agonists are more clearly demonstrated as first-line therapy.
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Affiliation(s)
- Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Sandra Goble
- Ferring Pharmaceuticals A/S, Copenhagen, Denmark
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De Maeseneer DJ, Van Praet C, Lumen N, Rottey S. Battling resistance mechanisms in antihormonal prostate cancer treatment: Novel agents and combinations. Urol Oncol 2015; 33:310-21. [DOI: 10.1016/j.urolonc.2015.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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Wyatt AW, Gleave ME. Targeting the adaptive molecular landscape of castration-resistant prostate cancer. EMBO Mol Med 2015; 7:878-94. [PMID: 25896606 PMCID: PMC4520654 DOI: 10.15252/emmm.201303701] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/12/2015] [Accepted: 03/26/2015] [Indexed: 12/19/2022] Open
Abstract
Castration and androgen receptor (AR) pathway inhibitors induce profound and sustained responses in advanced prostate cancer. However, the inevitable recurrence is associated with reactivation of the AR and progression to a more aggressive phenotype termed castration-resistant prostate cancer (CRPC). AR reactivation can occur directly through genomic modification of the AR gene, or indirectly via co-factor and co-chaperone deregulation. This mechanistic heterogeneity is further complicated by the stress-driven induction of a myriad of overlapping cellular survival pathways. In this review, we describe the heterogeneous and evolvable molecular landscape of CRPC and explore recent successes and failures of therapeutic strategies designed to target AR reactivation and adaptive survival pathways. We also discuss exciting areas of burgeoning anti-tumour research, and their potential to improve the survival and management of patients with CRPC.
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Affiliation(s)
- Alexander W Wyatt
- Vancouver Prostate Centre & Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin E Gleave
- Vancouver Prostate Centre & Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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69
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Saad F, Chi KN, Finelli A, Hotte SJ, Izawa J, Kapoor A, Kassouf W, Loblaw A, North S, Rendon R, So A, Usmani N, Vigneault E, Fleshner NE. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer (CRPC). Can Urol Assoc J 2015; 9:90-6. [PMID: 26085865 DOI: 10.5489/cuaj.2526] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Agents that have shown improvements in survival in mCRPC now include abiraterone, enzalutamide, docetaxel, cabazitaxel and radium-223. Bone supportive agents and palliative radiation continue to play an important role in the overall management of mCRPC. Given the complexity, variety and importance of optimizing the use of these agents, a multidisciplinary team approach is highly recommended.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | | | - Antonio Finelli
- University of Toronto, Princess Margaret Cancer Centre, Toronto, ON
| | | | | | | | | | - Andrew Loblaw
- Sunnybrook Health Sciences Centre, Toronto, University of Toronto, ON
| | - Scott North
- BC Cancer Agency, Vancouver, BC; ; Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Ricardo Rendon
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Alan So
- University of British Columbia, Vancouver, BC
| | - Nawaid Usmani
- Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Eric Vigneault
- l'Hotel-Dieu de Quebec, Université de Laval, Quebec City, QC
| | - Neil E Fleshner
- University of Toronto, Princess Margaret Cancer Centre, Toronto, ON
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Schalken J, Fitzpatrick JM. Enzalutamide: targeting the androgen signalling pathway in metastatic castration-resistant prostate cancer. BJU Int 2015; 117:215-25. [PMID: 25818596 PMCID: PMC4744713 DOI: 10.1111/bju.13123] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Significant progress has been made in the understanding of the underlying cancer biology of castration‐resistant prostate cancer (CRPC) with the androgen receptor (AR) signalling pathway remaining implicated throughout the prostate cancer disease continuum. Reactivation of the AR signalling pathway is considered to be a key driver of CRPC progression and, as such, the AR is a logical target for therapy in CRPC. The objective of this review was to understand the importance of AR signalling in the treatment of patients with metastatic CRPC (mCRPC) and to discuss the clinical benefits associated with inhibition of the AR signalling pathway. A search was conducted to identify articles relating to the role of AR signalling in CRPC and therapies that inhibit the AR signalling pathway. Current understanding of prostate cancer has identified the AR signalling pathway as a logical target for the treatment of CRPC. Available therapies that inhibit the AR signalling pathway include AR blockers, androgen biosynthesis inhibitors, and AR signalling inhibitors. Enzalutamide, the first approved AR signalling inhibitor, has a novel mode of action targeting AR signalling at three key stages. The direct mode of action of enzalutamide has been shown to translate into clinical responses in patients with mCRPC. In conclusion, the targeting of the AR signalling pathway in patients with mCRPC results in numerous clinical benefits. As the number of treatment options increase, more trials evaluating the sequencing and combination of treatments are required. This review highlights the continued importance of targeting a key driver in the progression of CRPC, AR signalling, and the clinical benefits associated with inhibition of the AR signalling pathway in the treatment of patients with CRPC.
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Affiliation(s)
- Jack Schalken
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - John M Fitzpatrick
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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71
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Lo EN, Beckett LA, Pan CX, Robles D, Suga JM, Sands JM, Lara PN. Prospective evaluation of low-dose ketoconazole plus hydrocortisone in docetaxel pre-treated castration-resistant prostate cancer patients. Prostate Cancer Prostatic Dis 2015; 18:144-8. [PMID: 25667107 PMCID: PMC4430382 DOI: 10.1038/pcan.2015.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ketoconazole is a well-known CYP17-targeted systemic treatment for castration-resistant prostate cancer (CRPC). However, most of the published data has been in the pre-chemotherapy setting; its efficacy in the post-chemotherapy setting has not been as widely described. Chemotherapy-naïve patients treated with attenuated doses of ketoconazole (200-300 mg three times daily) had PSA response rate (>50% decline) of 21-62%. We hypothesized that low-dose ketoconazole would likewise possess efficacy and tolerability in the CRPC post-chemotherapy state. METHODS Men with CRPC and performance status 0-3, adequate organ function and who had received prior docetaxel were treated with low-dose ketoconazole (200 mg orally three times daily) and hydrocortisone (20 mg PO qAM and 10 mg PO qPM) until disease progression. Primary endpoint was PSA response rate (>50% reduction from baseline) where a rate of 25% was to be considered promising for further study (versus a null rate of <5%); 25 patients were required. Secondary endpoints included PSA response >30% from baseline, progression-free survival (PFS), duration of stable disease and evaluation of adverse events (AEs). RESULTS Thirty patients were accrued with median age of 72 years (range 55-86) and median pre-treatment PSA of 73 ng ml(-1) (range 7-11,420). Twenty-nine patients were evaluable for response and toxicity. PSA response (>50% reduction) was seen in 48% of patients; PSA response (>30% reduction) was seen in 59%. Median PFS was 138 days; median duration of stable disease was 123 days. Twelve patients experienced grade 3 or 4 AEs. Of the 17 grade 3 AEs, only 3 were attributed to treatment. None of the two grade 4 AEs were considered related to treatment. CONCLUSIONS In docetaxel pre-treated CRPC patients, low-dose ketoconazole and hydrocortisone is a well-tolerated, relatively inexpensive and clinically active treatment option. PSA response to low-dose ketoconazole appears historically comparable to that of abiraterone in this patient context. A prospective, randomized study of available post-chemotherapy options is warranted to assess comparative efficacy.
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Affiliation(s)
- Ernest N. Lo
- University of California Davis Comprehensive Cancer Center, Sacramento CA
| | - Laurel A. Beckett
- University of California Davis Comprehensive Cancer Center, Sacramento CA
| | - Chong-Xian Pan
- University of California Davis Comprehensive Cancer Center, Sacramento CA
- VA Northern California Health Care System, Mather, CA
| | - Daniel Robles
- University of California Davis Comprehensive Cancer Center, Sacramento CA
| | | | | | - Primo N. Lara
- University of California Davis Comprehensive Cancer Center, Sacramento CA
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Proverbs-Singh T, Feldman JL, Morris MJ, Autio KA, Traina TA. Targeting the androgen receptor in prostate and breast cancer: several new agents in development. Endocr Relat Cancer 2015; 22:R87-R106. [PMID: 25722318 PMCID: PMC4714354 DOI: 10.1530/erc-14-0543] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 12/29/2022]
Abstract
Prostate cancer (PCa) and breast cancer (BCa) share similarities as hormone-sensitive cancers with a wide heterogeneity of both phenotype and biology. The androgen receptor (AR) is a hormone receptor involved in both benign and malignant processes. Targeting androgen synthesis and the AR pathway has been and remains central to PCa therapy. Recently, there has been increased interest in the role of the AR in BCa development and growth, with results indicating AR co-expression with estrogen, progesterone, and human epidermal growth factor receptors, across all intrinsic subtypes of BCa. Targeting the AR axis is an evolving field with novel therapies in development which may ultimately be applicable to both tumor types. In this review, we offer an overview of available agents which target the AR axis in both PCa and BCa and provide insights into the novel drugs in development for targeting this signaling pathway.
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Affiliation(s)
- Tracy Proverbs-Singh
- Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA
| | - Jarett L Feldman
- Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA
| | - Michael J Morris
- Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA
| | - Karen A Autio
- Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA
| | - Tiffany A Traina
- Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA Breast Medicine ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USAGenitourinary Oncology ServiceDepartment of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USAWeill Cornell Medical College1300 York Avenue, New York, New York 10065, USA
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López Torrecilla J, Hervás A, Zapatero A, Gómez Caamaño A, Macías V, Herruzo I, Maldonado X, Gómez Iturriaga A, Casas F, González San Segundo C. Uroncor consensus statement: Management of biochemical recurrence after radical radiotherapy for prostate cancer: From biochemical failure to castration resistance. Rep Pract Oncol Radiother 2015; 20:259-72. [PMID: 26109913 DOI: 10.1016/j.rpor.2015.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/17/2015] [Accepted: 04/06/2015] [Indexed: 12/24/2022] Open
Abstract
Management of patients who experience biochemical failure after radical radiotherapy with or without hormonal therapy is highly challenging. The clinician must not only choose the type of treatment, but also the timing and optimal sequence of treatment administration. When biochemical failure occurs, numerous treatment scenarios are possible, thus making it more difficult to select the optimal approach. Moreover, rapid and ongoing advances in treatment options require that physicians make decisions that could impact both survival and quality of life. The aim of the present consensus statement, developed by the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR), is to provide cancer specialists with the latest, evidence-based information needed to make the best decisions for the patient under all possible treatment scenarios. The structure of this consensus statement follows the typical development of disease progression after biochemical failure, with the most appropriate treatment recommendations given for each stage. The consensus statement is organized into three separate chapters, as follows: biochemical failure with or without local recurrence and/or metastasis; progression after salvage therapy; and treatment of castration-resistant patients.
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Affiliation(s)
- José López Torrecilla
- Servicio Oncología Radioterápica-ERESA, Hospital General Universitario, Valencia, Spain
| | - Asunción Hervás
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Almudena Zapatero
- Radiation Oncology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Antonio Gómez Caamaño
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Victor Macías
- Servicio de Oncología Radioterápica, Hospital Universitario de Salamanca, Valencia, Spain
| | - Ismael Herruzo
- Servicio de Oncología Radioterápica, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Xavier Maldonado
- Servicio de Oncología Radioterápica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alfonso Gómez Iturriaga
- Servicio de Oncología Radioterápica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Francesc Casas
- Servicio Oncología Radioterápica, Hospital Clinic, Barcelona, Spain
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Carreira S, Romanel A, Goodall J, Grist E, Ferraldeschi R, Miranda S, Prandi D, Lorente D, Frenel JS, Pezaro C, Omlin A, Rodrigues DN, Flohr P, Tunariu N, S de Bono J, Demichelis F, Attard G. Tumor clone dynamics in lethal prostate cancer. Sci Transl Med 2015; 6:254ra125. [PMID: 25232177 DOI: 10.1126/scitranslmed.3009448] [Citation(s) in RCA: 281] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It is unclear whether a single clone metastasizes and remains dominant over the course of lethal prostate cancer. We describe the clonal architectural heterogeneity at different stages of disease progression by sequencing serial plasma and tumor samples from 16 ERG-positive patients. By characterizing the clonality of commonly occurring deletions at 21q22, 8p21, and 10q23, we identified multiple independent clones in metastatic disease that are differentially represented in tissue and circulation. To exemplify the clinical utility of our studies, we then showed a temporal association between clinical progression and emergence of androgen receptor (AR) mutations activated by glucocorticoids in about 20% of patients progressing on abiraterone and prednisolone or dexamethasone. Resistant clones showed a complex dynamic with temporal and spatial heterogeneity, suggesting distinct mechanisms of resistance at different sites that emerged and regressed depending on treatment selection pressure. This introduces a management paradigm requiring sequential monitoring of advanced prostate cancer patients with plasma and tumor biopsies to ensure early discontinuation of agents when they become potential disease drivers.
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Affiliation(s)
| | - Alessandro Romanel
- Centre for Integrative Biology, University of Trento, Trento 38123, Italy
| | - Jane Goodall
- The Institute of Cancer Research, London SM2 5NG, UK
| | - Emily Grist
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | - Roberta Ferraldeschi
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | | | - Davide Prandi
- Centre for Integrative Biology, University of Trento, Trento 38123, Italy
| | - David Lorente
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | | | - Carmel Pezaro
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | - Aurelius Omlin
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | | | | | - Nina Tunariu
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | - Johann S de Bono
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
| | - Francesca Demichelis
- Centre for Integrative Biology, University of Trento, Trento 38123, Italy. Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY 10021, USA. Institute for Precision Medicine, Weill Cornell Medical College, New York, NY 10021, USA.
| | - Gerhardt Attard
- The Institute of Cancer Research, London SM2 5NG, UK. Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK.
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75
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Han CS, Patel R, Kim IY. Pharmacokinetics, pharmacodynamics and clinical efficacy of abiraterone acetate for treating metastatic castration-resistant prostate cancer. Expert Opin Drug Metab Toxicol 2015; 11:967-75. [DOI: 10.1517/17425255.2015.1041918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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76
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Markowski MC, Pienta KJ. Therapy decisions for the symptomatic patient with metastatic castration-resistant prostate cancer. Asian J Androl 2015; 17:936-8; discussion 938. [PMID: 25865849 PMCID: PMC4814966 DOI: 10.4103/1008-682x.150843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Metastatic prostate cancer continues to kill approximately 30,000 men per year. Since 2010, five new therapeutic agents have been Food and Drug Administration (FDA) approved to treat metastatic castration-resistant prostate cancer (mCRPC). With the increasing number of therapies available to clinicians, the most effective sequence in which to implement these treatments remains unknown. The presence or absence of symptoms (i.e., bony pain, visceral crisis) is a key parameter that informs the decision-making process regarding therapy. Treatment algorithms based on: 1) asymptomatic/minimal symptoms, 2) moderate symptoms or chemotherapy ineligible or 3) symptomatic disease need to be developed.
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Affiliation(s)
| | - Kenneth J Pienta
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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77
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Venkitaraman R, Lorente D, Murthy V, Thomas K, Parker L, Ahiabor R, Dearnaley D, Huddart R, De Bono J, Parker C. A randomised phase 2 trial of dexamethasone versus prednisolone in castration-resistant prostate cancer. Eur Urol 2015; 67:673-9. [PMID: 25457497 DOI: 10.1016/j.eururo.2014.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prednisolone is widely used as secondary hormonal treatment for castration-resistant prostate cancer (CRPC). We hypothesised that dexamethasone, another corticosteroid, is more active. OBJECTIVE To compare the activity of prednisolone and dexamethasone in CRPC. DESIGN, SETTING, AND PARTICIPANTS This single-centre, randomised, phase 2 trial was performed in 82 men with chemotherapy-naïve CRPC enrolled from 2006 to 2010. INTERVENTION Prednisolone 5mg twice daily versus dexamethasone 0.5mg once daily versus intermittent dexamethasone 8mg twice daily on days 1-3 every 3 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main end point was prostate-specific antigen (PSA) response rate. Secondary end points included time to PSA progression, radiologic response rate using Response Evaluation Criteria In Solid Tumors (RECIST), and safety. RESULTS AND LIMITATIONS The intermittent dexamethasone arm was dropped after no response was seen in seven patients. By intention to treat, confirmed PSA response was seen in 41% versus 22% for daily dexamethasone versus prednisolone, respectively (p=0.08). In evaluable patients, the PSA response rates were 47% versus 24% for dexamethasone and prednisolone, respectively (p=0.05). Median time to PSA progression was 9.7 mo on dexamethasone versus 5.1 mo on prednisolone (hazard ratio: 1.6; 95% confidence interval, 0.9-2.8). In 43 patients with measurable disease, the response rate by RECIST was 15% and 6% for dexamethasone and prednisolone, respectively (p=0.6). Of 23 patients who crossed over at PSA progression on prednisolone, 7 of the 19 evaluable (37%) had a confirmed PSA response to dexamethasone. Clinically significant toxicities were rare. CONCLUSIONS Dexamethasone may be more active than prednisolone in CRPC. In the absence of more definitive trials, dexamethasone should be used in preference to prednisolone. PATIENT SUMMARY We compared two different steroids used for treating men with advanced prostate cancer. Our results suggest that dexamethasone may be more effective than prednisolone and that both are well tolerated. CLINICAL TRIAL REGISTRY EUDRAC 2005-006018-16.
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Affiliation(s)
| | | | - Vedang Murthy
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
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78
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Bicalutamide 150 mg as secondary hormonal therapy for castration-resistant prostate cancer. Int Urol Nephrol 2015; 47:479-84. [PMID: 25665794 DOI: 10.1007/s11255-015-0919-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/22/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE This study was aimed to evaluate the effect and tolerability of bicalutamide 150 mg therapy in patients with castration-resistant prostate cancer (CRPC). METHODS A total of 48 patients with histologically confirmed prostate cancer were included. They had been treated with continuous maximal androgen blockade therapy, but their serum prostate-specific antigen (PSA) increased after initial hormonal therapy. Patients were given bicalutamide (150 mg per day). Serum PSA testing was performed every 3 months. The response was defined according to PSA decline from baseline: PSA decline ≥85% as complete response, ≥50 % but <85% as partial response, and <50 % as failure. Response duration was defined as the time from PSA response until PSA increased ≥25 % or ≥2 ng/mL from the nadir. The potential predictive factors (Gleason score, clinical stage and serum PSA) were investigated. RESULTS The time of follow-up was 3-30 months. A PSA decline ≥50% was observed in 37 of 48 patients including 18 ≥ 50% but <85% and 19 ≥ 85% responders. The median response duration was 12 months for partial responders and 20 months for complete responders. Patients with lower Gleason score, lower serum PSA and using flutamide as first-line nonsteroidal antiandrogen achieved more benefits. Moreover, bicalutamide 150 mg therapy was well tolerated. CONCLUSIONS Bicalutamide 150 mg therapy was an appropriate therapeutic method for patients of CRPC, especially for those with lower Gleason score, lower serum PSA and using flutamide as first-line nonsteroidal antiandrogen.
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79
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Carthon B, Rossi PJ. Update on systemic therapy for advance prostate cancer. Curr Probl Cancer 2015; 39:52-62. [PMID: 25637932 DOI: 10.1016/j.currproblcancer.2014.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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80
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Cowan AJ, Inoue Y, Yu EY. Delayed antiandrogen withdrawal syndrome after discontinuation of bicalutamide. Clin Genitourin Cancer 2015; 13:e51-3. [PMID: 25450034 PMCID: PMC4289435 DOI: 10.1016/j.clgc.2014.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew J Cowan
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA
| | | | - Evan Y Yu
- University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA.
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81
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Sadarangani SP, Estes LL, Steckelberg JM. Non-anti-infective effects of antimicrobials and their clinical applications: a review. Mayo Clin Proc 2015; 90:109-27. [PMID: 25440726 DOI: 10.1016/j.mayocp.2014.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 12/12/2022]
Abstract
Antimicrobial agents are undoubtedly one of the key advances in the history of modern medicine and infectious diseases, improving the clinical outcomes of infection owing to their inhibitory effects on microbial growth. However, many antimicrobial agents also have biological activities stemming from their interactions with host receptors and effects on host inflammatory responses and other human or bacterial cellular biological pathways. These result in clinical uses of antimicrobial drugs that are distinct from their direct bacteriostatic or bactericidal properties. We reviewed the published literature regarding non-anti-infective therapeutic properties and proposed clinical applications of selected antimicrobials, specifically, macrolides, tetracyclines, sulfonamides, and ketoconazole. The clinical applications reviewed were varied, and we focused on uses that were clinically relevant (in terms of importance and burden of disease) and where published evidence exists. Such uses include chronic inflammatory pulmonary and skin disorders, chronic periodontitis, gastrointestinal dysmotility, rheumatoid arthritis, and cancer. Most of these potential therapeutic uses are not Food and Drug Administration approved. Clinicians need to weigh the use of antimicrobial agents for their non-anti-infective benefits, considering potential adverse effects and long-term effect on microbial resistance.
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Affiliation(s)
| | - Lynn L Estes
- Hospital Pharmacy Services, Mayo Clinic, Rochester, MN
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82
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Grist E, de Bono JS, Attard G. Targeting extra-gonadal androgens in castration-resistant prostate cancer. J Steroid Biochem Mol Biol 2015; 145:157-63. [PMID: 25251387 DOI: 10.1016/j.jsbmb.2014.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/04/2014] [Accepted: 09/06/2014] [Indexed: 01/28/2023]
Abstract
Metastatic castration resistant prostate cancer (CRPC) is associated with a rise in PSA, suggesting an increase in transcription of steroid receptor regulated genes. The efficacy of the new anti-androgen therapies abiraterone and enzalutamide, that target extra-gonadal activation of androgen signaling, confirm CRPC's addiction to genes regulated by the androgen receptor (AR). However, patients invariably progress and develop resistance. This review focuses on mechanisms of drug resistance associated with the AR and steroidogenesis in CRPC. Understanding this persistent dependency and adaptation to the androgen axis in CRPC will lead to an understanding of resistance to new licensed therapies and to novel drug discovery, ultimately improving clinical outcome in CRPC. This article is part of a Special Issue entitled 'Essential role of DHEA'.
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Affiliation(s)
- Emily Grist
- Institute of Cancer Research, Cancer Therapeutics, 15 Cotswold Rd, Sutton, Surrey SM25NG, UK; Royal Marsden NHS Foundation Trust, London, UK.
| | - Johann S de Bono
- Institute of Cancer Research, Cancer Therapeutics, 15 Cotswold Rd, Sutton, Surrey SM25NG, UK; Royal Marsden NHS Foundation Trust, London, UK
| | - Gerhardt Attard
- Institute of Cancer Research, Cancer Therapeutics, 15 Cotswold Rd, Sutton, Surrey SM25NG, UK; Royal Marsden NHS Foundation Trust, London, UK.
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83
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Labrie F. Combined blockade of testicular and locally made androgens in prostate cancer: a highly significant medical progress based upon intracrinology. J Steroid Biochem Mol Biol 2015; 145:144-56. [PMID: 24925260 DOI: 10.1016/j.jsbmb.2014.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Recently two drugs, namely the antiandrogen MDV-3100 and the inhibitor of 17α-hydroxylase abiraterone have been accepted by the FDA for the treatment of castration-resistant prostate cancer (CRPC) with or without previous chemotherapy, with a prolongation of overall survival of 2.2-4.8 months. While medical (GnRH agonist) or surgical castration reduces the serum levels of testosterone by about 97%, an important concentration of testosterone and dihydrotestosterone remains in the prostate and activates the androgen receptor (AR), thus offering an explanation for the positive data obtained in CRPC. In fact, explanation of the response observed with MDV-3100 or enzalutamide in CRPC is essentially a blockade of the action or formation of intraprostatic androgens. In addition to the inhibition of the action or formation of androgens made locally by the mechanisms of intracrinology, increased AR levels and AR mutations can be involved, especially in very advanced disease. Future developments look at more efficient inhibitors of the action or formation of intraprostatic androgens and starting treatment earlier when blockade of androgens can exert long-term control and even cure prostate cancer treated at a stage before the appearance of metastases. This article is part of a Special Issue entitled 'Essential role of DHEA'.
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84
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Zhang T, Zhu J, George DJ, Armstrong AJ. Enzalutamide versus abiraterone acetate for the treatment of men with metastatic castration-resistant prostate cancer. Expert Opin Pharmacother 2014; 16:473-85. [DOI: 10.1517/14656566.2015.995090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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85
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Obinata D, Fujiwara K, Yamaguchi K, Takayama KI, Urano T, Nagase H, Inoue S, Takahashi S, Fukuda N. Review of novel therapeutic medicines targeting androgen signaling in castration-resistant prostate cancer. World J Clin Urol 2014; 3:264-271. [DOI: 10.5410/wjcu.v3.i3.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer is the most common male malignant neoplasm. Androgens and the androgen receptor (AR) play a key role in the onset and progression of prostate cancer. The expression of the AR is still preserved in the majority of patients with castration-resistant prostate cancer (CRPC). CRPC is considered to be induced by the following mechanisms: (1) sustained AR activation by enhancing intracellular conversion of adrenal androgens to dehydrotestosterone via a de novo route; (2) AR hypersensitivity; (3) promiscuous activation of AR signaling; and (4) outlaw pathways. Recent advances in the treatment of CRPC include novel medicines targeting AR signaling pathways. In addition, functional molecular studies have shown that some of the AR-regulated genes and AR coregulators are prognostic markers and potential therapeutic targets for prostate cancer, particularly in the castration-resistant state. Therefore, identification of the AR signaling pathways responsible for establishment of CRPC is critical for developing new strategies for the treatment of CRPC.
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86
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Rodriguez-Vida A, Bianchini D, Van Hemelrijck M, Hughes S, Malik Z, Powles T, Bahl A, Rudman S, Payne H, de Bono J, Chowdhury S. Is there an antiandrogen withdrawal syndrome with enzalutamide? BJU Int 2014; 115:373-80. [DOI: 10.1111/bju.12826] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Diletta Bianchini
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research; Sutton UK
| | - Mieke Van Hemelrijck
- King's College London; Division of Cancer Studies; Cancer Epidemiology Group; London UK
| | - Simon Hughes
- Guy's and St Thomas' NHS Foundation Trust; Great Maze Pond; London UK
| | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust; Bebington UK
| | - Thomas Powles
- St. Bartholomew's Hospital NHS Foundation Trust; London UK
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Sarah Rudman
- Guy's and St Thomas' NHS Foundation Trust; Great Maze Pond; London UK
| | | | - Johann de Bono
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research; Sutton UK
| | - Simon Chowdhury
- Guy's and St Thomas' NHS Foundation Trust; Great Maze Pond; London UK
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87
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Kim W, Zhang L, Wilton JH, Fetterly G, Mohler JL, Weinberg V, Morse A, Szmulewitz RZ, Friedlander TW, Fong L, Lin AM, Harzstark AL, Molina A, Small EJ, Ryan CJ. Sequential use of the androgen synthesis inhibitors ketoconazole and abiraterone acetate in castration-resistant prostate cancer and the predictive value of circulating androgens. Clin Cancer Res 2014; 20:6269-76. [PMID: 25336698 DOI: 10.1158/1078-0432.ccr-14-1595] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients previously treated with ketoconazole were excluded from phase III trials of abiraterone acetate due to potential overlapping mechanism of action. The purpose of this study was to determine the clinical utility of abiraterone and its impact on circulating androgens following ketoconazole. EXPERIMENTAL DESIGN Chemotherapy-naïve patients with progressive metastatic castration-resistant prostate cancer (mCRPC) and prior ketoconazole therapy ≥28 days received abiraterone acetate 1,000 mg daily and prednisone 5 mg twice daily. The primary endpoint was the proportion of patients with PSA response, defined as ≥30% PSA decline at 12 weeks. H0 = 0.30 versus H1 = 0.50 (α = 0.05, power = 0.83). Circulating androgen levels were measured using liquid chromatography tandem mass spectrometry. RESULTS Thirty-nine patients were included in the final analysis. Twenty (51%; 95% confidence interval, 36%-66%) patients had ≥30% PSA decline; the null hypothesis was rejected. Sixteen (41%) had ≥50% PSA decline. Median PFS (progression-free survival) was 16 weeks; median radiographic PFS (rPFS) was 36 weeks. Samples for measurement of baseline androgens were available in 37 patients. The PSA response proportion was 59% in 29 patients with DHEA ≥ limit of quantitation (LOQ), compared with 13% in 8 patients with DHEA < LOQ (P = 0.042). Median PFS was 6 and 16 weeks in DHEA < LOQ and DHEA ≥ LOQ patients, respectively (P = 0.017); median rPFS was 14 and 36 weeks in DHEA < LOQ and DHEA ≥ LOQ patients, respectively (P < 0.001). CONCLUSIONS Abiraterone demonstrates modest clinical efficacy in mCRPC patients previously treated with ketoconazole. Patients with DHEA ≥ LOQ were more likely to demonstrate PSA responses and longer PFS. Analysis of circulating androgens merits further investigation as a biomarker for response to androgen synthesis inhibitor therapy.
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Affiliation(s)
- Won Kim
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.
| | - Li Zhang
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - John H Wilton
- Department of Medicine, PK/PD Core Resource, Roswell Park Cancer Institute, Buffalo, New York
| | - Gerald Fetterly
- Department of Medicine, PK/PD Core Resource, Roswell Park Cancer Institute, Buffalo, New York
| | - James L Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Vivian Weinberg
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Allison Morse
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | | | - Terence W Friedlander
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Lawrence Fong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Amy M Lin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Andrea L Harzstark
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Arturo Molina
- Janssen Research and Development, Menlo Park, California
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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88
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Basch E, Loblaw DA, Oliver TK, Carducci M, Chen RC, Frame JN, Garrels K, Hotte S, Kattan MW, Raghavan D, Saad F, Taplin ME, Walker-Dilks C, Williams J, Winquist E, Bennett CL, Wootton T, Rumble RB, Dusetzina SB, Virgo KS. Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. J Clin Oncol 2014; 32:3436-48. [PMID: 25199761 PMCID: PMC4876355 DOI: 10.1200/jco.2013.54.8404] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). METHODS The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. RESULTS When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 ((223)Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. RECOMMENDATIONS Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or (223)Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to evaluate optimal sequences or combinations of therapies. Palliative care should be offered to all patients.
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Affiliation(s)
- Ethan Basch
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - D Andrew Loblaw
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Thomas K Oliver
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Michael Carducci
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Ronald C Chen
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - James N Frame
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Kristina Garrels
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Sebastien Hotte
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Michael W Kattan
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Derek Raghavan
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Fred Saad
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Mary-Ellen Taplin
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Cindy Walker-Dilks
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - James Williams
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Eric Winquist
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Charles L Bennett
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Ted Wootton
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - R Bryan Rumble
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Stacie B Dusetzina
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
| | - Katherine S Virgo
- Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA
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89
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Pham S, Deb S, Ming DS, Adomat H, Hosseini-Beheshti E, Zoubeidi A, Gleave M, Guns EST. Next-generation steroidogenesis inhibitors, dutasteride and abiraterone, attenuate but still do not eliminate androgen biosynthesis in 22RV1 cells in vitro. J Steroid Biochem Mol Biol 2014; 144 Pt B:436-44. [PMID: 25201454 DOI: 10.1016/j.jsbmb.2014.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/15/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022]
Abstract
Castration resistant prostate cancer (CRPC) is often lethal and inevitably develops after androgen ablation therapy. However, in the majority of cases it remains androgen dependent. CRPC tumors have the ability to synthesize their own androgens from cholesterol by engaging in de novo steroidogenesis. We investigated the potential of 22RV1 prostate cancer cells to convert the supplemented steroid precursors within this pathway under the effects of current clinical steroidogenesis inhibitors such as abiraterone and dutasteride, either alone or in combination. Under steroid starved conditions, enzymes responsible for de novo steroidogenesis were upregulated. Testosterone and dihydrotestosterone (DHT) were formed by using both dehydroepiandrosterone (DHEA) and progesterone as substrates. Formation of testosterone and DHT was higher following incubation with DHEA compared to progesterone. Progesterone decreased the mRNA expression of enzymes responsible for steroidogenesis. Abiraterone treatment decreased testosterone production but increased several precursor steroids in both classical and backdoor pathways in the presence of progesterone. In contrast, the DHT levels were elevated following treatment with abiraterone when progesterone was absent. Dutasteride decreased the formation of testosterone, DHT and precursor steroids in the backdoor pathway but increased steroid precursors in the classical steroidogenesis pathway. The combination of abiraterone and dutasteride decreased testosterone and DHT in the presence of progesterone but increased DHT in the absence of progesterone. Abiraterone inhibited androgen receptor (AR) activation but not to the same extent as MDV3100. However, abiraterone and dutasteride treatment, either alone or in combination, were more effective in decreasing prostate specific antigen secretion into the media than MDV3100. Thus, while interventions with these drugs alone or in combination fail to completely inhibit steroidogenesis in the 22RV1 cells, the combined inhibition of androgen production and blockade of AR can exceed the effect of MDV3100. Further characterization of bypass mechanisms that may develop as a response to these inhibitors is necessary to achieve optimal suppression of testosterone and DHT synthesis as a part of therapeutic regimens for the treatment of CRPC.
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Affiliation(s)
- Steven Pham
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Subrata Deb
- Department of Biopharmaceutical Sciences, Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA
| | - Dong Sheng Ming
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Hans Adomat
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Elham Hosseini-Beheshti
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Amina Zoubeidi
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin Gleave
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Emma S Tomlinson Guns
- The Vancouver Prostate Centre at Vancouver General Hospital, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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90
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Alkhateeb S, Abusamra A, Rabah D, Alotaibi M, Mahmood R, Almansour M, Murshid E, Alsharm A, Alolayan A, Ahmad I, Alkushi H, Alghamdi A, Bazarbashi S. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2014; 6:278-285. [PMID: 25371601 PMCID: PMC4216530 DOI: 10.4103/0974-7796.140959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7(th) edition. The recommendations are presented with supporting evidence level.
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Affiliation(s)
- Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City-Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Section of Urology, Department of Surgery, King Khaled Hospital, King Abdulaziz Medical City-Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Princess Al Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rana Mahmood
- Section of Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Oncology department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ashwaq Alolayan
- Department of Oncology, King Abdulaziz Medical City-Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hussain Alkushi
- Oncology department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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91
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Quinn DI, Vaishampayan U, Higano CS, Lin DW, Shore ND, Beer TM. Sequencing therapy in advanced prostate cancer: focus on sipuleucel-T. Expert Rev Anticancer Ther 2014; 14:51-61. [PMID: 24224900 DOI: 10.1586/14737140.2014.848065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Immunotherapies such as sipuleucel-T present new and unique challenges for the optimal timing and sequencing of therapies for metastatic castration-resistant prostate cancer (mCRPC). Key considerations for the sequencing of sipuleucel-T are its unique proposed mechanism of action, the time required to generate a clinically relevant immune response, and the observed efficacy in Phase III trials in 'early' or asymptomatic or minimally symptomatic mCRPC. There are three broad timing and sequencing options for sipuleucel-T in patients with rising prostate-specific antigen and radiologic evidence of disease: immediately after androgen-deprivation therapy failure, after failure of secondary hormonal maneuvers, or after chemotherapy. There are several other agents in Phase III development in mCRPC and any future approvals will impact on the current treatment algorithm, and raise further questions regarding how to optimize sequencing and timing of therapies for better clinical outcomes.
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Affiliation(s)
- David I Quinn
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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92
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Eisenberger MA. Words of wisdom. Re: Phase I clinical trial of a selective inhibitor of CYP17, abiraterone acetate, confirms that castration-resistant prostate cancer commonly remains hormone driven. Attard G, Reide AHM, Yap TA, Raynaud F, Dowsett M, Settatree S, Barrett M, Parker C, Martins V, Folkerd E, Clark J, Cooper C, Kaye S, Dearnaley D, Lee G, de Bono JS. J Clin Oncol 2008;26:4563-71. Eur Urol 2014; 55:248. [PMID: 20050017 DOI: 10.1016/j.eururo.2008.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mario A Eisenberger
- Johns Hopkins University-School of Medicine, Oncology Center, East Baltimore Campus, CRB 1M-Oncology, 1650 Orleans Street, Baltimore, MD 21231-1000, USA.
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93
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Leibowitz-Amit R, Seah JA, Atenafu EG, Templeton AJ, Vera-Badillo FE, Alimohamed N, Knox JJ, Tannock IF, Sridhar SS, Joshua AM. Abiraterone acetate in metastatic castration-resistant prostate cancer: A retrospective review of the Princess Margaret experience of (I) low dose abiraterone and (II) prior ketoconazole. Eur J Cancer 2014; 50:2399-407. [DOI: 10.1016/j.ejca.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
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94
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Carver BS. Strategies for targeting the androgen receptor axis in prostate cancer. Drug Discov Today 2014; 19:1493-7. [PMID: 25107669 DOI: 10.1016/j.drudis.2014.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/14/2014] [Indexed: 01/27/2023]
Abstract
Androgen receptor (AR) signaling plays a critical role in prostate cancer cell proliferation, survival, and differentiation. Therapeutic strategies targeting the androgen receptor have been developed for the treatment of metastatic hormone-naïve prostate cancer; however, despite effective targeting recent studies have demonstrated that during progression to a castrate-resistant phenotype there is restoration of AR target gene expression. On the basis of this observation, second-generation therapeutics have been developed to target AR in the castrate-resistant setting resulting in a survival benefit. In this review we will discuss the mechanisms promoting AR signaling and the development of second-generation therapeutics targeting AR in castrate-resistant prostate cancer.
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Affiliation(s)
- Brett S Carver
- Department of Surgery, Division of Urology and Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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95
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Hoy SM. Abiraterone acetate: a review of its use in patients with metastatic castration-resistant prostate cancer. Drugs 2014; 73:2077-91. [PMID: 24271422 DOI: 10.1007/s40265-013-0150-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abiraterone acetate (Zytiga(®)) is an orally administered, selective inhibitor of the 17α-hydroxylase and C17,20-lyase enzymatic activities of cytochrome P450 (CYP) 17. CYP17 is required for androgen biosynthesis, with androgen receptor signalling crucial in the progression from primary to metastatic prostate cancer. Abiraterone acetate is approved in the European Union and the US, in combination with prednisone or prednisolone, for the treatment of men with metastatic castration-resistant prostate cancer (CRPC). When administered in combination with prednisone in a placebo-controlled, multinational phase III study, abiraterone acetate significantly prolonged overall survival and radiographic progression-free survival (rPFS) in men with metastatic CRPC who had previously received docetaxel. In men with metastatic CRPC who had not previously received chemotherapy participating in a placebo-controlled, multinational phase III study, there was a strong trend towards an overall survival benefit, a significant prolongation in rPFS and significant delays in clinical decline, the need for chemotherapy and the onset of pain observed. Given the nature of the therapy, the overall tolerability profile of abiraterone acetate, in combination with prednisone, was acceptable in men with metastatic CRPC. Abiraterone acetate is associated with hypokalaemia, hypertension, and fluid retention or oedema, secondary to its mechanism of action, and with cardiac adverse events and hepatotoxicity; however, in the phase III studies the incidences of the most frequently reported grade 3 or 4 adverse events of special interest were relatively low. Although the final overall survival data in men with metastatic CRPC who have not previously received chemotherapy are awaited, current evidence indicates that abiraterone acetate is a useful option for the treatment of metastatic CRPC.
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Affiliation(s)
- Sheridan M Hoy
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand,
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Gupta E, Guthrie T, Tan W. Changing paradigms in management of metastatic Castration Resistant Prostate Cancer (mCRPC). BMC Urol 2014; 14:55. [PMID: 25062956 PMCID: PMC4167156 DOI: 10.1186/1471-2490-14-55] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/17/2014] [Indexed: 11/14/2022] Open
Abstract
Recently, the standard of care for metastatic Castration Resistant Prostate Cancer (mCRPC) has changed considerably. Persistent androgen receptor (AR) signaling has been identified as a target for novel therapies and reengages the fact that AR continues to be the primary target responsible for metastatic prostate cancer. Androgen receptor gene amplification and over expression have been found to result in a higher concentration of androgen receptors on tumor cells, making them extremely sensitive to low levels of circulating androgens. Additionally, prostate cancer cells are able to maintain dihydrotestosterone (DHT) concentration in excess of serum concentrations to support tumor growth. For many years ketoconazole was the only CYP17 inhibitor that was used to treat mCRPC. However, significant toxicities limit its use. Newly approved chemotherapeutic agents such as Abiraterone (an oral selective inhibitor of CYP17A), which blocks androgen biosynthesis both within and outside the prostate cancer cells), and enzalutamide (blocks AR signaling) have improved overall survival. There are also ongoing phase III trials for Orteronel (TAK- 700), ARN- 509 and Galeterone (TOK-001), which targets androgen signaling. In this review, we will present the rationale for the newly approved hormonal treatments, their indications and complications, and we will discuss ongoing trials that are being done to improve the efficacy of the approved agents. Finally, we will talk about the potential upcoming hormonal treatments for mCRPC.
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Affiliation(s)
- Eva Gupta
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville 32224, FL, USA
| | | | - Winston Tan
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville 32224, FL, USA
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Mottet N, Clarke N, De Santis M, Zattoni F, Morote J, Joniau S. Implementing newer agents for the management of castrate-resistant prostate cancer: what is known and what is needed? BJU Int 2014; 115:364-72. [PMID: 24628790 DOI: 10.1111/bju.12736] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Men receiving androgen-deprivation therapy will in time develop metastatic castrate-resistant prostate cancer (mCRPC). Whilst effective treatment options for mCRPC have traditionally been limited, new agents are becoming available. Since 2010, the number and class of agents available to treat mCRPC has increased dramatically. As such, there is a need for clear guidance on the optimum treatment and sequence of treatments for mCRPC before and after chemotherapy. This evidence-based statement, reflecting the views of the authors, provides suggestions on the continued relevance of conventional approaches to first- and second-line treatment in mCRPC, the potential role of novel treatments, and factors that may influence the choice of hormonal agents and/or chemotherapy.
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Suzman DL, Antonarakis ES. Castration-resistant prostate cancer: latest evidence and therapeutic implications. Ther Adv Med Oncol 2014; 6:167-79. [PMID: 25057303 PMCID: PMC4107711 DOI: 10.1177/1758834014529176] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Medical oncologists who treat men with castration-resistant prostate cancer (CRPC) have seen an abundance of new agents approved by the United States Food and Drug Administration in the last decade for a disease that was previously difficult to treat after becoming resistant to androgen-deprivation therapy. Advances in understanding of the mechanisms of castration-resistance and prostate cancer progression have highlighted several pathways and targets that appear promising to better treat CRPC. As the majority of CRPC appears to continue to rely on the androgen receptor for growth and progression, several of these agents directly or indirectly target the androgen receptor. A novel microtubule-targeted agent, cabazitaxel, has demonstrated an overall survival benefit following progression on docetaxel. Other agents target tumor immunogenicity and immune checkpoint pathways to attempt to harness the host immune system. The recently approved radiopharmaceutical, radium-223 dichloride, has demonstrated impressive results in patients with extensive bony metastases with minimal toxicity. Lastly, further understanding of the pathways underlying CRPC progression has led to late-phase clinical trials with the novel agents: custirsen, tasquinimod and cabozantinib. This article reviews the approved therapies for CRPC, the agents currently in late-phase clinical trials, and notable early-phase trials of novel therapies and their combinations, with particular attention to trials incorporating novel biomarkers and intermediate endpoints to better identify those men who may or may not benefit from specific therapies.
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Affiliation(s)
- Daniel L Suzman
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Emmanuel S Antonarakis
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 1650 Orleans Street, CRB1-1M45, Baltimore, MD 21287, USA
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Colloca G, Venturino A, Governato I. End points of clinical trials in metastatic castration-resistant prostate cancer: A systematic review. World J Methodol 2014; 4:123-132. [PMID: 25332911 PMCID: PMC4202480 DOI: 10.5662/wjm.v4.i2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/19/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the definition and performance of the commonly used end points in trials of systemic therapies in metastatic castration-resistant prostate cancer patients.
METHODS: A literature search was undertaken on PubMed database to identify studies meeting established criteria, with the aim of selecting randomized clinical trials and study definition and performance of their end points. The end points were grouped into three categories: overall survival (OS), time-to-event end points, and response end points. A special analysis was performed for secondary end points of the studies which documented a benefit in OS in the experimental arm. Finally, publishes analyses for surrogacy of the included end points were also reported.
RESULTS: OS, time-to-event and response end points in 31 selected trials were analyzed. OS was the primary end point in 14 trials, and the secondary end point in 17. A time-to-event end point was the primary end point in 8 studies, and the secondary end point in 22; the most reported time-to-event end points were composite end points, and the events changed among trials. A response end point was the primary end point in 9 studies, in 3 it was prostate-specific antigen (PSA)-related, in 3 pain-related and in 3 mixed. A response end point was the secondary end point in 19 studies: PSA response and radiologic response were the most frequently used secondary end points in 19 and 11 trials, respectively, while pain response was used in 5 studies.
CONCLUSION: A homogeneous definition of progression in future trials is mandatory. Among response end points, pain-response and PSA-response appear to be the most reliable.
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Kübler H, Miller K. [New therapy concepts for castration-resistant prostate cancer: between hormone manipulation, targeted therapy and chemotherapy]. Urologe A 2014; 52:1517-8, 1520-1, 1524-6 passim. [PMID: 24166056 DOI: 10.1007/s00120-013-3247-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Within the last 2 years the therapeutic landscape of castration-resistant prostate cancer (CRPC) has dramatically changed. While chemotherapy with docetaxel has only shown a survival benefit in CRPC patients in the last 10 years, in the meantime 4 approved drugs are available for this indication and approval for immunotherapy with sipuleucel-T is expected. Docetaxel still plays a significant role in the treatment of CRPC but is also a cesura in the therapeutic sequence. For asymptomatic or minimally symptomatic, chemotherapy naive CRPC patients a significant survival benefit was shown for treatment with the androgen biosynthesis inhibitor abiraterone. Clinical data for the antiandrogen enzalutamide are expected shortly for this indication. For patients where docetaxel has failed abiraterone, enzalutamide and cabazitaxel have shown survival benefits in phase III trials. The radionuclide alpharadin not only palliated morbidity induced by bone metastases but also prolonged survival of CRPC patients. This review deals with the various drugs with respect to mode of action, clinical results and indications and will focus on new treatment options, such as targeted therapy with cabozantinib or immunotherapy with sipuleucel-T and prostvac.
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Affiliation(s)
- H Kübler
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland,
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