Interstitial pneumonitis induced by bicalutamide given for prostate cancer

Interstitial lung disease induced by apalutamide therapy for castration‐resistant prostate cancer: A report of a rare case

Introduction

Apalutamide is a new second‐generation anti‐androgen agent approved in 2019 for the treatment of metastatic, castration‐sensitive, and non‐metastatic, castration‐resistant prostate cancer. We herein report a case of apalutamide‐induced interstitial lung disease.

Case presentation

A 74‐year‐old Japanese male patient with non‐metastatic, castration‐resistant prostate cancer commenced hormonal therapy with apalutamide (240 mg/day orally) after 46 months of maximal androgen blockade therapy with bicalutamide and leuprorelin. Thirty‐five days following therapy initiation with apalutamide, he was hospitalized because of dyspnea. Chest computed tomography showed diffuse bilateral interstitial infiltrates and ground‐glass opacities in the upper and lower lobes of the lungs. Following a diagnosis of drug‐induced interstitial lung disease resulting from apalutamide treatment, the treatment with apalutamide was stopped. Steroid therapy was initiated, and the dyspnea resolved.

Conclusion

Clinicians should be aware that apalutamide, and other drugs in general, can cause drug‐induced interstitial lung disease within 3 months.

Interstitial pneumonitis associated with leuprorelin acetate for a prostate cancer: A case report

INTRODUCTION

Androgen deprivation therapy remains the essential treatment for disseminated prostate cancer. Interstitial pneumonitis following this therapy has been documented for just a few cases. However, reported cases frequently describe the onset of symptoms after recent administration (days or a few weeks) of both GnRH analogues and androgen antagonists, which makes the precise individual impact of each treatment difficult to estimate.

CASE REPORT

This report presents a case of a 94-year-old patient with interstitial pneumonitis whose onset started three months after the first dose of leuprorelin and bicalutamide for a metastatic prostate cancer.

MANAGEMENT AND OUTCOME

Once other possible diagnosis were ruled out, empiric corticosteroid treatment was initiated within 48 h of the admission. A spectacular clinical and radiological improvement was observed after 3 doses of steroids, enabling the patient to recover his basal respiratory situation. We considered that the most probable cause was toxic interstitial pneumonitis induced by leuprorelin.

DISCUSSION

To our knowledge, it describes the longest interval between last administration of antiandrogen therapy and the development of pneumonitis. This fact may support a direct relation with leuprorelin, whose serum levels remain high for months because of its long-acting depot formulation.

[DRUG-INDUCED INTERSTITIAL LUNG DISEASE DURING COMBINED ANDROGEN BLOCKADE WITH BICALUTAMIDE AND LEUPRORELIN ACETATE FOR PROSTATE CANCER]

We report a case of drug-induced interstitial lung disease as a result of combined androgen blockade. A 75 year-old male was receiving bicalutamide and reuprorelin acetate treatment for advanced prostate cancer. Two weeks after starting therapy, the patient developed dyspnea due to interstitial lung disease. Based on the clinical diagnosis of drug-induced interstitial lung disease, bicalutamide was withdrawn and steroid therapy was initiated. The patient succumbed 6 days later due to respiratory failure. Drug-induced interstitial lung disease following combined androgen blockade is a rare, but potentially serious adverse effect that requires close attention.

Safety of antiandrogen therapy for treating prostate cancer

INTRODUCTION

Antiandrogens are a treatment option in patients with prostate cancer, given either in combination with androgen deprivation or, in selected cases, as monotherapy. New-generation antiandrogens have been recently introduced in clinical practice (enzalutamide) or are under evaluation in clinical trials (ARN-509).

AREAS COVERED

This review elucidates the safety profile of antiandrogens, in particular focusing on the tolerability profile of each drug either when employed in combination with castration or as monotherapy, in hormone-naive or in castration-resistant patients.

EXPERT OPINION

Non-steroidal antiandrogens are widely used in the management of hormone-sensitive disease in combination with luteinizing hormone-releasing hormone agonists or in patients failing front-line treatment with androgen-deprivative maneuvers. In selected patients, non-steroidal antiandrogen monotherapy appears to yield comparable results as castration. Novel non-steroidal antiandrogens have been investigated with promising results in castration-resistant prostate cancer. Beyond the safety profile specific to any individual compound, increased testosterone and 17β-estradiol levels are commonly observed during antiandrogen monotherapy, leading to gynecomastia and breast pain. The safety profile of old and novel antiandrogens should be taken into account by clinicians in decision making and in selecting the most suitable patients. Beyond patient selection, full clinical evaluation of patient co-morbidities that might affect the drug tolerability and clinical monitoring are anyway required.

Clinical predictor of survival following docetaxel-based chemotherapy

Prostate cancer (PCa) is the most common type of cancer in males in the USA and the incidence is increasing. For castration-resistant PCa (CRPC), previous studies have identified docetaxel-based chemotherapy as the first-line therapy. In the present study, the efficacy of docetaxel-based chemotherapy was investigated in a population of patients with CRPC. This study included 26 individuals (mean age, 73 years) with CRPC who were patients between July 2007 and October 2012 at the Kaohsiung Medical University Hospital (Kaohsiung, Taiwan). The regimen consisted of intravenous docetaxel (70 mg/m²) once every four weeks plus oral prednisolone (5 mg) twice daily for five days. Prostate-specific antigen (PSA) response (defined as a PSA decrease of >50% over four weeks), time to PSA progression, PCa-specific survival and overall survival (OS) were evaluated. For these 26 patients, the mean PSA level prior to chemotherapy treatment was 335.58 ng/ml. During follow-up, the average number of cycles of chemotherapy was approximately seven and 15 patients (58%) achieved a PSA response. PSA response was found to significantly correlate with OS and PCa-specific survival (P=0.014 and P=0.028, respectively). The mean value of the PSA nadir level was 89.97 ng/ml and time to PSA nadir was five months. The most common adverse event was leucopenia, which affected 88% of the patients. The results indicated that the length of time to PSA nadir and the occurrence of leucopenia may impact the PSA response. The docetaxel-based chemotherapy was a feasible and effective treatment regimen in patients with CRPC. However, the occurrence of adverse events, particularly the high incidence of leucopenia, may be cause for concern.