Cancer Biology & Therapy
ISSN: 1538-4047 (Print) 1555-8576 (Online) Journal homepage: http://www.tandfonline.com/loi/kcbt20
Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer S L Holder, J Drabick, J Zhu & M Joshi To cite this article: S L Holder, J Drabick, J Zhu & M Joshi (2015) Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer, Cancer Biology & Therapy, 16:2, 207-209, DOI: 10.1080/15384047.2014.1002687 To link to this article: http://dx.doi.org/10.1080/15384047.2014.1002687
© 2015 The Author(s). Published with license by Taylor & Francis© S L Holder, J Drabick, J Zhu, and M Joshi Published online: 10 Mar 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=kcbt20 Download by: [University of California, San Diego]
Date: 05 November 2015, At: 22:06
JOURNAL CLUB Cancer Biology & Therapy 16:2, 207--209; February 2015; Published with license by Taylor & Francis
Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer S L Holder1,*, J Drabick1, J Zhu2, and M Joshi1 1
Division of Hematology/Oncology; Department of Internal Medicine; Penn State Milton S. Hershey Cancer Institute; Hershey, PA USA; 2Department of Public
Downloaded by [University of California, San Diego] at 22:06 05 November 2015
Health Sciences; Penn State College of Medicine, Hershey, PA USA
C
Keywords: castration-resistant prostate cancer, dexamethasone, prednisolone, prednisone © S L Holder, J Drabick, J Zhu, and M Joshi *Correspondence to: S L Holder; [email protected]
Email:
Submitted: 11/18/2014 Revised: 11/18/2014 Accepted: 12/18/2014 http://dx.doi.org/10.1080/15384047.2014.1002687 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/ licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. Comment on: Ramachandran Venkitaramana, David Lorenteb, Vedang Murthyc, Karen Thomasd, Lydia Parkerb, Ruth Ahiaborb, David Dearnaleyb, Robert Huddartb, Johann De Bonob, and Chris Parkerd. A Randomized Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration-resistant Prostate Cancer. Eur Urol (2014). In press. http://dx. doi.org/10.1016/j.eururo.2014.10.004
www.taylorandfrancis.com
orticosteroids have been used in the therapy for castration-resistant prostate cancer (CRPC) for decades, both as monotherapy and in combination with additional agents. In this article the authors report the results of a phase II trial of dexamethasone versus prednisolone as monotherapy for CRPC. The study suggests improved PSA and radiographic response rates as well as improved time to PSA progression for dexamethasone over prednisolone therapy; however the differences only trend toward statistical significance. Nonetheless, in light of these data, when treating patients with corticosteroid monotherapy for CRPC it may be prudent to consider using daily dexamethasone over prednisone/prednisolone. In the article entitled A Randomized Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration Resistant Prostate Cancer, Venkitaraman et al., report the results of the first head to head trial of dexamethasone vs. prednisolone as monotherapy in castration-resistant prostate cancer (CRPC).1 Corticosteroids have been known to have activity as monotherapy in CRPC for decades and currently remain an integral part of the therapeutic regimen, particularly in combination with cytotoxic chemotherapy or androgen synthesis inhibitors. Although many previous studies used prednisone in CRPC, this study used prednisolone. It should be noted that prednisone is distinctly different from prednisolone, but is converted to prednisolone by hepatic enzymes. This study seeks to determine if there is a difference Cancer Biology & Therapy
in efficacy between dexamethasone and prednisolone when used as monotherapy in CPRC. There are data suggesting improved efficacy of dexamethasone over prednisone in other disease types. For example, a meta-analysis evaluating the efficacy of dexamethasone versus prednisone in childhood acute lymphoblastic leukemia (ALL) found that dexamethasone was superior to prednisone for induction therapy.2 In a recent report of results of the EORTC CLG 58951 study it was shown that dexamethasone was equivalent to prednisolone for induction therapy for ALL; however, dexamethasone was found to be superior to prednisolone for preventing central nervous system relapse.3 Here the authors conducted a phase II, single center, randomized, open-label study among chemotherapy na€ıve CRPC patients who had not received prior abiraterone or enzalutamide therapy. Inclusion criteria included histologically proven adenocarcinoma of the prostate or sclerotic bone lesions and a presenting prostatespecific antigen (PSA) > 100 ng/ml. All participants had castrate levels of testosterone (
ISSN: 1538-4047 (Print) 1555-8576 (Online) Journal homepage: http://www.tandfonline.com/loi/kcbt20
Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer S L Holder, J Drabick, J Zhu & M Joshi To cite this article: S L Holder, J Drabick, J Zhu & M Joshi (2015) Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer, Cancer Biology & Therapy, 16:2, 207-209, DOI: 10.1080/15384047.2014.1002687 To link to this article: http://dx.doi.org/10.1080/15384047.2014.1002687
© 2015 The Author(s). Published with license by Taylor & Francis© S L Holder, J Drabick, J Zhu, and M Joshi Published online: 10 Mar 2015.
Submit your article to this journal
Article views: 385
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=kcbt20 Download by: [University of California, San Diego]
Date: 05 November 2015, At: 22:06
JOURNAL CLUB Cancer Biology & Therapy 16:2, 207--209; February 2015; Published with license by Taylor & Francis
Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer S L Holder1,*, J Drabick1, J Zhu2, and M Joshi1 1
Division of Hematology/Oncology; Department of Internal Medicine; Penn State Milton S. Hershey Cancer Institute; Hershey, PA USA; 2Department of Public
Downloaded by [University of California, San Diego] at 22:06 05 November 2015
Health Sciences; Penn State College of Medicine, Hershey, PA USA
C
Keywords: castration-resistant prostate cancer, dexamethasone, prednisolone, prednisone © S L Holder, J Drabick, J Zhu, and M Joshi *Correspondence to: S L Holder; [email protected]
Email:
Submitted: 11/18/2014 Revised: 11/18/2014 Accepted: 12/18/2014 http://dx.doi.org/10.1080/15384047.2014.1002687 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/ licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. Comment on: Ramachandran Venkitaramana, David Lorenteb, Vedang Murthyc, Karen Thomasd, Lydia Parkerb, Ruth Ahiaborb, David Dearnaleyb, Robert Huddartb, Johann De Bonob, and Chris Parkerd. A Randomized Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration-resistant Prostate Cancer. Eur Urol (2014). In press. http://dx. doi.org/10.1016/j.eururo.2014.10.004
www.taylorandfrancis.com
orticosteroids have been used in the therapy for castration-resistant prostate cancer (CRPC) for decades, both as monotherapy and in combination with additional agents. In this article the authors report the results of a phase II trial of dexamethasone versus prednisolone as monotherapy for CRPC. The study suggests improved PSA and radiographic response rates as well as improved time to PSA progression for dexamethasone over prednisolone therapy; however the differences only trend toward statistical significance. Nonetheless, in light of these data, when treating patients with corticosteroid monotherapy for CRPC it may be prudent to consider using daily dexamethasone over prednisone/prednisolone. In the article entitled A Randomized Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration Resistant Prostate Cancer, Venkitaraman et al., report the results of the first head to head trial of dexamethasone vs. prednisolone as monotherapy in castration-resistant prostate cancer (CRPC).1 Corticosteroids have been known to have activity as monotherapy in CRPC for decades and currently remain an integral part of the therapeutic regimen, particularly in combination with cytotoxic chemotherapy or androgen synthesis inhibitors. Although many previous studies used prednisone in CRPC, this study used prednisolone. It should be noted that prednisone is distinctly different from prednisolone, but is converted to prednisolone by hepatic enzymes. This study seeks to determine if there is a difference Cancer Biology & Therapy
in efficacy between dexamethasone and prednisolone when used as monotherapy in CPRC. There are data suggesting improved efficacy of dexamethasone over prednisone in other disease types. For example, a meta-analysis evaluating the efficacy of dexamethasone versus prednisone in childhood acute lymphoblastic leukemia (ALL) found that dexamethasone was superior to prednisone for induction therapy.2 In a recent report of results of the EORTC CLG 58951 study it was shown that dexamethasone was equivalent to prednisolone for induction therapy for ALL; however, dexamethasone was found to be superior to prednisolone for preventing central nervous system relapse.3 Here the authors conducted a phase II, single center, randomized, open-label study among chemotherapy na€ıve CRPC patients who had not received prior abiraterone or enzalutamide therapy. Inclusion criteria included histologically proven adenocarcinoma of the prostate or sclerotic bone lesions and a presenting prostatespecific antigen (PSA) > 100 ng/ml. All participants had castrate levels of testosterone (
