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Cai M, Song XL, Li XA, Chen M, Guo J, Yang DH, Chen Z, Zhao SC. Current therapy and drug resistance in metastatic castration-resistant prostate cancer. Drug Resist Updat 2023; 68:100962. [PMID: 37068396 DOI: 10.1016/j.drup.2023.100962] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/06/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023]
Abstract
Castration-resistant prostate cancer (CRPC), especially metastatic castration-resistant prostate cancer (mCRPC) is one of the most prevalent malignancies and main cause of cancer-related death among men in the world. In addition, it is very difficult for clinical treatment because of the natural or acquired drug resistance of CRPC. Mechanisms of drug resistance are extremely complicated and how to overcome it remains an urgent clinical problem to be solved. Thus, a comprehensive and thorough understanding for mechanisms of drug resistance in mCRPC is indispensable to develop novel and better therapeutic strategies. In this review, we aim to review new insight of the treatment of mCRPC and elucidate mechanisms governing resistance to new drugs: taxanes, androgen receptor signaling inhibitors (ARSIs) and poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi). Most importantly, in order to improve efficacy of these drugs, strategies of overcoming drug resistance are also discussed based on their mechanisms respectively.
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Affiliation(s)
- Maoping Cai
- Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, PR China; The Third Clinical College, Southern Medical University, Guangzhou 510630, Guangdong, PR China; Zhanjiang Institute of Clinical Medicine, Central People's Hospital of Zhanjiang, Zhanjiang 524045, Guangdong, PR China
| | - Xian-Lu Song
- Department of Radiotherapy, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, PR China
| | - Xin-An Li
- School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, Guangdong, PR China
| | - Mingkun Chen
- Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, PR China; The Third Clinical College, Southern Medical University, Guangzhou 510630, Guangdong, PR China; Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, PR China
| | - Jiading Guo
- Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, PR China; The Third Clinical College, Southern Medical University, Guangzhou 510630, Guangdong, PR China
| | - Dong-Hua Yang
- New York College of Traditional Chinese Medicine, Mineola 11501, NY, USA.
| | - Zhanghui Chen
- Zhanjiang Institute of Clinical Medicine, Central People's Hospital of Zhanjiang, Zhanjiang 524045, Guangdong, PR China.
| | - Shan-Chao Zhao
- Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, PR China; The Third Clinical College, Southern Medical University, Guangzhou 510630, Guangdong, PR China; Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, PR China.
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Pak S, Suh J, Park SY, Kim Y, Cho YM, Ahn H. Glucocorticoid receptor and androgen receptor-targeting therapy in patients with castration-resistant prostate cancer. Front Oncol 2022; 12:972572. [PMID: 36212458 PMCID: PMC9541428 DOI: 10.3389/fonc.2022.972572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The glucocorticoid receptor (GR) promotes resistance to androgen receptor (AR)-targeting therapies in castration-resistant prostate cancer (CRPC) by bypassing AR blockade. However, the clinical relevance of evaluating GR expression in patients with CRPC has not been determined. The present study investigated the association of relative GR expression in CRPC tissue samples with treatment response to AR-targeting therapy. Methods Levels of GR, AR-FL, and AR-V7 mRNAs were measured in prostate cancer tissue from prospectively enrolled CRPC patients who were starting treatment. Patients were divided into groups with high and low AR-V7/AR-FL ratios and with high and low GR/AR-FL ratios. The primary endpoint was prostate-specific antigen (PSA) response rate to treatment. Results Evaluation of 38 patients treated with AR-targeting therapies showed that the PSA response rate was significantly higher in patients with low than high AR-V7/AR-FL ratios (77.8% vs. 25.0%, p=0.003) and in patients with low than high GR/AR-FL ratios (81.3% vs. 27.3%, p=0.003). Patients with low GR/AR-FL ratios had higher rates of PSA progression-free survival (46.0% vs. 22.4%, p=0.006), radiologic progression-free survival (28.9% vs. 10.0%, p=0.02), and overall survival (75.2% vs. 48.0%, p=0.037) than patients with high GR/AR-FL ratios. The association of GR/AR-FL ratio with PSA response to AR-targeting therapy remained significant in multivariable models. Evaluation of the 14 patients who received taxane chemotherapy showed that PSA response rates did not differ significantly in those with low and high AR-V7/AR-FL and GR/AR-FL ratios, although no definitive conclusions can be drawn due to the small number of patients. Conclusion Relative GR expression is associated with sensitivity to AR-targeting therapy and survival in patients with CRPC. Large-scale prospective validation and liquid biopsy-based studies are warranted.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Hallym University College of Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul, South Korea
| | - Yunlim Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- Asan Institute for Life Science, Asan Medical Center, Seoul, South Korea
| | - Yong Mee Cho
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Xiong X, Qiu S, Yi X, Xu H, Liao D, Lei H, Bai S, Peng G, Ai J, Yang L. Steroid switch after progression on abiraterone plus prednisone in patients with metastatic castration-resistant prostate cancer: A systematic review. Urol Oncol 2021; 39:754-763. [PMID: 34330654 DOI: 10.1016/j.urolonc.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Emerging evidence indicates that patients with metastatic castration-resistant prostate cancer could respond to steroid switch from prednisone (P) to dexamethasone (D) following progression on abiraterone acetate plus prednisone (AA+P). OBJECTIVES Conducting a systematic review to evaluate the efficacy, safety, and prognostic factors of steroid switch. MATERIALS AND METHODS We systematically searched Pubmed, Web of Science, and American Society of Clinical Oncology annual meeting abstracts published up to October 2020. Literature review, study selection, and data extraction were conducted by two reviewers. Risk of bias (RoB) and quality of evidence were assessed. A systematic review and pooled analysis were performed. RESULTS Nine studies were eligible for inclusion. All of the included patients were progression on AA+P. Pooled rates of PSA50 and PSA30 on abiraterone acetate plus dexamethasone (AA+D) were 0.24 (95%CI [0.18,0.30]) and 0.42 (95%CI [0.36,0.48]), respectively. Subgroup analysis indicated more favorable PSA50 and PSA30 rates on AA+D when switching from P to D only based on PSA progression. Median time to PSA progression on AA+D ranged from 2.73 to 11.38 months. Definitions of progression free survival were variable. Reported median progression free survival on AA+D ranged from 2.52 to 11.8 months. Median overall survival on AA+D varied from 4.11 to 20.9 months. All patients tolerated well on AA+D, and no grade 3 to 4 adverse events were reported. Baseline characteristics of patients, previous treatment and its response, and genetic alterations might all play roles in the response in the response toward the AA+D regimen. CONCLUSIONS The present systematic review suggested that steroid switch from P to D might be an effective and safe treatment strategy in a subset of patients with metastatic castration-resistant prostate cancer after PSA progression on AA+P.
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Affiliation(s)
- Xingyu Xiong
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China; Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China
| | - Xianyanling Yi
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Dazhou Liao
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Haoran Lei
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Shengjiang Bai
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
| | - Lu Yang
- Department of Urology, Institute of Urology, Center of National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
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Hou Z, Huang S, Li Z. Androgens in prostate cancer: A tale that never ends. Cancer Lett 2021; 516:1-12. [PMID: 34052327 DOI: 10.1016/j.canlet.2021.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022]
Abstract
Androgens play an essential role in prostate cancer. Clinical treatments that target steroidogenesis and the androgen receptor (AR) successfully postpone disease progression. Abiraterone and enzalutamide, the next-generation androgen receptor pathway inhibitors (ARPI), emphasize the function of the androgen-AR axis even in castration-resistant prostate cancer (CRPC). However, with the increased incidence in neuroendocrine prostate cancer (NEPC) showing resistance to ARPI, the importance of androgen-AR axis in further disease management remains elusive. Herein we review the steroidogenic pathways associated with different disease stages and discuss the potential targets for disease management after manifesting resistance to abiraterone and enzalutamide.
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Affiliation(s)
- Zemin Hou
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China
| | - Shengsong Huang
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Zhenfei Li
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, China; Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
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