1
|
Soo A, O'Callaghan ME, Kopsaftis T, Vatandoust S, Moretti K, Kichenadasse G. PSA response to antiandrogen withdrawal: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2021; 24:826-836. [PMID: 33603235 DOI: 10.1038/s41391-021-00337-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiandrogen withdrawal (AAW) response is the paradoxical decrease in prostate-specific antigen (PSA) following the withdrawal of antiandrogen in patients with advanced prostate cancer. Currently, the reported literature on the proportion of patients exhibiting AAW response and the differences in PSA response between the types of antiandrogens is unclear. METHODS This review aimed to explore the PSA response to AAW and to identify if the response depends on the type of antiandrogens. A literature search was performed using databases PubMed, Cochrane and EMBASE with a cut-off date of 23rd of November 2020. Studies reporting on outcomes of AAW and prostate cancer were included. Studies were screened by two reviewers and relevant data extracted. Meta-analysis of outcomes was reported using random-effects and fixed-effects model. A subgroup analysis was performed for type of antiandrogen. RESULTS From 450 studies, 23 were included with a total of 1474 patients with advanced prostate cancer were available for further analysis. Overall, 395 (26%) patients had any reduction in PSA levels (95% CI: 20-32%) and 183 (11%) patients had a ≥50% reduction in PSA levels (95% CI: 6-16%). Among the 1212 patients on first-generation antiandrogens, 30% (95% CI: 23-38%) had any PSA decline with 15% patients having a ≥50% PSA decline (95% CI: 8-22%). In contrast, among the 108 patients on second-generation antiandrogens, 7% (95% CI: 0-13%) had any PSA decline and only 1% (95% CI: 0-5%) had a ≥50% PSA decline. Also, among the 154 patients on androgen synthesis inhibitors, 26% (95% CI: 19-33%) had any PSA decline and only 4% (95% CI: 0-13%) had a ≥50% PSA decline. CONCLUSIONS One-fourth of patients treated with AAW show a PSA response. However, PSA response to AAW is uncommon with second-generation antiandrogens and androgen synthesis inhibitors. Further research is required to understand the differences in response between the types of antiandrogen.
Collapse
Affiliation(s)
- Alwin Soo
- School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Michael E O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Urology, Flinders Medical Centre, Bedford Park, SA, Australia.,Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Tina Kopsaftis
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Urology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sina Vatandoust
- School of Medicine, Flinders University, Bedford Park, SA, Australia.,Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia
| | - Kim Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Bedford Park, SA, Australia.,Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.,School of Population Health, University of South Australia, Adelaide, SA, Australia.,Monash University, Clayton, VIC, Australia
| | - Ganessan Kichenadasse
- School of Medicine, Flinders University, Bedford Park, SA, Australia. .,Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Bedford Park, SA, Australia.
| |
Collapse
|
2
|
Lemmo W. Anti-Estrogen Withdrawal Effect With Raloxifene? A Case Report. Integr Cancer Ther 2016; 15:245-9. [PMID: 27411856 PMCID: PMC5739193 DOI: 10.1177/1534735416658954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/17/2016] [Indexed: 12/25/2022] Open
Abstract
A 66-year-old patient presented with acute recurrent metastatic estrogen and progesterone receptor–positive, Her-2/neu-negative breast cancer, bone lesions (lumbar spine, pelvis), pulmonary nodules, hepatic metastasis, elevated cancer antigen 15 and liver enzymes, dyspepsia, and diarrhea. The patient had been taking raloxifene for approximately 8 years. After discontinuation, clinical parameters and symptoms improved rapidly without oncological therapy or other forms of treatment. Three months after raloxifene discontinuation, capecitabine was initiated by the treating oncologist who deemed an anti-estrogen withdrawal effect (AEWE) implausible. However, the lasting regression was more indicative of a raloxifene rebound effect than chemotherapy or other interventions. Today, the patient is asymptomatic with a good performance status. Hepatic metastatic regression has been confirmed, without any oncological treatment administered in the past 16 months and approximately 23 months following the withdrawal of raloxifene. This case highlights the need to screen breast cancer patients for the possibility of an AEWE if they are using raloxifene and possibly similar selective estrogen receptor modulators (SERMs) which includes tamoxifen, when diagnosed with advanced breast cancer, especially in the recurrent disease setting.
Collapse
Affiliation(s)
- Walter Lemmo
- LEMMO Integrated Cancer Care Inc, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Heidegger I, Massoner P, Eder IE, Pircher A, Pichler R, Aigner F, Bektic J, Horninger W, Klocker H. Novel therapeutic approaches for the treatment of castration-resistant prostate cancer. J Steroid Biochem Mol Biol 2013; 138:248-56. [PMID: 23792785 PMCID: PMC3834152 DOI: 10.1016/j.jsbmb.2013.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/10/2022]
Abstract
Prostate cancer is a leading cause of cancer death in men in developed countries. Once the tumor has achieved a castration-refractory metastatic stage, treatment options are limited with the average survival of patients ranging from two to three years only. Recently, new drugs for treatment of castration-resistant prostate cancer (CRPC) have been approved, and others are in an advanced stage of clinical testing. In this review we provide an overview of the new therapeutic agents that arrived in the clinical praxis or are tested in clinical studies and their mode of action including hormone synthesis inhibitors, new androgen receptor blockers, bone targeting and antiangiogenic agents, endothelin receptor antagonists, growth factor inhibitors, novel radiotherapeutics and taxanes, and immunotherapeutic approaches. Results and limitations from clinical studies as well as future needs for improvement of CRPC treatments are critically discussed.
Collapse
Affiliation(s)
- Isabel Heidegger
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Petra Massoner
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Iris E. Eder
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Andreas Pircher
- Department of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
- Corresponding author at: Department of Urology, Division of Experimental Urology, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 24818; fax: +43 512 504 24817.
| |
Collapse
|
4
|
Cornford P. Evolution of Docetaxel-Based Therapy for Metastatic Castrate-Resistant Prostate Cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.bjmsu.2010.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Until the publication of the SWOG 99–16 [1] and TAX 327 [2] trials in 2004, urologists understood that only purely palliative treatment was available for men with prostate cancer that was progressive despite androgen deprivation. However, following the establishment of docetaxel-based chemotherapy as an active treatment option for most men with metastatic disease, researchers have focused their questions on the optimal timing of treatment. Should docetaxel be considered after one or two lines of hormone manipulation? Is it necessary to wait until the patient has bone pain? In latter years, the research focus has widened to embrace second-line and even third-line chemotherapy for this patient group, raising the possibility of advanced prostate cancer being managed as a chronic condition. This article looks at the evolution of docetaxel-based chemotherapy in advanced prostate cancer, and considers the next likely developments.
Collapse
Affiliation(s)
- Philip Cornford
- Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| |
Collapse
|