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

作　　者：Yu-Chao Ni Jin-Ge Zhao Meng-Ni Zhang Yi-Jun Zhang Zhen-Yu Yang Ni Chen Jun-Ru Chen Peng-Fei Shen Guang-Xi Sun Xing-Ming Zhang Yong-Hong Li Hao Zeng 

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

出　　处：《Asian Journal of Andrology》2022年第2期154-160,共7页亚洲男性学杂志（英文版）

基　　金：This work was supported by the Natural Science Foundation of China(NSFC,No.81672547,81872107,81872108,81972502,81902577,and 81902577);1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.0040205301E21);the Research Foundation for the Postdoctoral Program of Sichuan University(2021SCU12014);Postdoctoral Research Project,West China Hospital,Sichuan University(20HXBH026).

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

关 键 词：abiraterone acetate alkaline phosphatase corticosteroid switching DEXAMETHASONE metastatic castration-resistant prostate cancer 

分 类 号：R737.25[医药卫生—肿瘤]