TY - JOUR
T1 - The influence of prednisone on the efficacy of docetaxel in men with metastatic castration-resistant prostate cancer
AU - Teply, B. A.
AU - Luber, B.
AU - Denmeade, S. R.
AU - Antonarakis, E. S.
N1 - Funding Information:
This work was partially supported by an NIH grant T32 CA009071 (to BAT), a Conquer Cancer Foundation of ASCO Young Investigator Award (to BAT) and by an NIH grant P30 CA006973 (to ESA and SRD).
Funding Information:
Clinical/radiographic PFS for the entire docetaxel-treated population (depicted in Figure 1) was the primary end point. In an unadjusted analysis, PFS was superior in the docetaxel/ prednisone group compared with the docetaxel-alone group (median PFS: 7.8 vs 6.2 months, HR 0.68 (95% CI 0.48–0.97), P = 0.03). The clinical/radiographic PFS advantage for the docetaxel/prednisone cohort was supported by the difference in the number of chemotherapy cycles received. On average, the docetaxel/prednisone cohort received 7.3 cycles of docetaxel compared with 5.7 cycles for the docetaxel-alone cohort. These numbers corresponded to a median of 7 cycles (range 1–19) vs 6 cycles (range 1–13) for docetaxel/prednisone and docetaxel-alone cohorts, respectively.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Prednisone and other corticosteroids can provide palliation and tumor responses in patients with prostate cancer. The combination of docetaxel and prednisone was the first treatment shown to prolong survival in men with metastatic castration-resistant prostate cancer (mCRPC). Since the approval of docetaxel in 2004, additional treatments are available, including abiraterone, which is also administered with prednisone. Therefore, patients are increasingly likely to have prednisone therapy several times throughout their disease course, and the contribution of prednisone to the efficacy of docetaxel is unknown.Methods:We conducted a retrospective study of patients with mCPRC treated with docetaxel at our institution between 2004 and 2014. Patients were divided into two cohorts based upon whether prednisone was co-administered with docetaxel. Cohorts were further stratified based upon prior prednisone (with abiraterone) or hydrocortisone (with ketoconazole) use. The primary end point was clinical/radiographic progression-free survival (PFS). The secondary end points were >50% PSA response rate and PSA progression-free survival (PSA PFS). A multivariable Cox regression model was constructed to determine whether prednisone use was independently predictive of PFS.Results:We identified 200 consecutive patients for inclusion in the study: 131 men received docetaxel with prednisone and 69 received docetaxel alone. The docetaxel-prednisone cohort had superior PFS compared with the docetaxel-alone cohort (median PFS: 7.8 vs 6.2 months, HR 0.68 (95% confidence interval (CI) 0.48-0.97), P=0.03). Prednisone use was associated with a reduced risk of progression on docetaxel in the propensity score-weighted multivariable Cox model (P=0.002). Among abiraterone-or ketoconazole-pretreated patients, no difference in PFS was observed between prednisone-containing and non-prednisone-containing docetaxel regimens (median PFS: 7.1 vs 6.3 months, HR 0.96 (95% CI 0.59-1.57), P=0.87).Conclusions:The incorporation of prednisone potentially augments the efficacy of docetaxel in patients with mCRPC. We hypothesize that this advantage is limited to patients who have not previously received corticosteroids. Prospective confirmation is needed.
AB - Prednisone and other corticosteroids can provide palliation and tumor responses in patients with prostate cancer. The combination of docetaxel and prednisone was the first treatment shown to prolong survival in men with metastatic castration-resistant prostate cancer (mCRPC). Since the approval of docetaxel in 2004, additional treatments are available, including abiraterone, which is also administered with prednisone. Therefore, patients are increasingly likely to have prednisone therapy several times throughout their disease course, and the contribution of prednisone to the efficacy of docetaxel is unknown.Methods:We conducted a retrospective study of patients with mCPRC treated with docetaxel at our institution between 2004 and 2014. Patients were divided into two cohorts based upon whether prednisone was co-administered with docetaxel. Cohorts were further stratified based upon prior prednisone (with abiraterone) or hydrocortisone (with ketoconazole) use. The primary end point was clinical/radiographic progression-free survival (PFS). The secondary end points were >50% PSA response rate and PSA progression-free survival (PSA PFS). A multivariable Cox regression model was constructed to determine whether prednisone use was independently predictive of PFS.Results:We identified 200 consecutive patients for inclusion in the study: 131 men received docetaxel with prednisone and 69 received docetaxel alone. The docetaxel-prednisone cohort had superior PFS compared with the docetaxel-alone cohort (median PFS: 7.8 vs 6.2 months, HR 0.68 (95% confidence interval (CI) 0.48-0.97), P=0.03). Prednisone use was associated with a reduced risk of progression on docetaxel in the propensity score-weighted multivariable Cox model (P=0.002). Among abiraterone-or ketoconazole-pretreated patients, no difference in PFS was observed between prednisone-containing and non-prednisone-containing docetaxel regimens (median PFS: 7.1 vs 6.3 months, HR 0.96 (95% CI 0.59-1.57), P=0.87).Conclusions:The incorporation of prednisone potentially augments the efficacy of docetaxel in patients with mCRPC. We hypothesize that this advantage is limited to patients who have not previously received corticosteroids. Prospective confirmation is needed.
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U2 - 10.1038/pcan.2015.53
DO - 10.1038/pcan.2015.53
M3 - Article
C2 - 26857146
AN - SCOPUS:84957850895
VL - 19
SP - 72
EP - 78
JO - Prostate Cancer and Prostatic Diseases
JF - Prostate Cancer and Prostatic Diseases
SN - 1365-7852
IS - 1
ER -