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Ah-Thiane L, Campion L, Allouache N, Meyer E, Pommier P, Mesgouez-Nebout N, Serre AA, Créhange G, Guimas V, Rio E, Sargos P, Ladoire S, Mahier Ait Oukhatar C, Supiot S. Combination of Abiraterone Acetate, Prostate Bed Radiotherapy, and Luteinizing Hormone-releasing Hormone Agonists in Biochemically Relapsing Patients After Prostatectomy (CARLHA): A Phase 2 Clinical Trial. Eur Urol Oncol 2024:S2588-9311(24)00108-1. [PMID: 38734543 DOI: 10.1016/j.euo.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/26/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The relevance of next-generation hormone therapies and circulating tumor cells (CTCs) are not elucidated in biochemical recurrence after prostatectomy. OBJECTIVE To evaluate the combination of abiraterone acetate plus prednisone (AAP), prostate bed radiotherapy (PBRT), and goserelin in biochemically relapsing men after prostatectomy, and to investigate the utility of CTCs. DESIGN, SETTING, AND PARTICIPANTS In this single-arm multicenter phase 2 trial, 46 biochemically relapsing men were enrolled between December 2012 and January 2019. The median follow-up was 47 mo. INTERVENTION All patients received AAP 1000 mg daily (but 750 mg during PBRT), salvage PBRT, and goserelin. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was 3-yr biochemical recurrence-free survival (bRFS) when prostate-specific antigen (PSA) levels were ≥0.2 ng/ml. The secondary outcomes included alternative bRFS (alt-bRFS) when PSA levels were ≥0.5 ng/ml and safety assessment. CTC count was assessed. RESULTS AND LIMITATIONS The 3-yr bRFS and alt-bRFS were 81.5% (95% confidence interval or CI [66.4-90.3%]) and 95.6% (95% CI [83.5-98.9%]), respectively. The most common acute radiotherapy-related adverse effect (AE; all grades was pollakiuria (41.3%). The most common late AE (all grades) was urinary incontinence (15.2%). Grade 3-4 acute or late radiotherapy-related AEs were scarce. Most frequent AEs nonrelated to radiotherapy were hot flashes (76%), hypertension (63%), and hepatic cytolysis (50%, of which 20% were of grades 3-4). Of the patients, 11% had a CTC count of ≥5, which was correlated with poorer bRFS (p = 0.042) and alt-bRFS (p = 0.008). The association between CTC count and higher rates of relapse was independent of the baseline PSA level and PSA doubling time (p = 0.42 and p = 0.09, respectively). This study was nonrandomized with a limited number of patients, and few clinical events were reported. CONCLUSIONS Adding AAP to salvage radiation therapy and goserelin resulted in high bRFS and alt-bRFS. AEs remained manageable, although a close liver surveillance is advised. CTC count appears as a promising biomarker for prognosis and predicting response to treatment. PATIENT SUMMARY Our study was a phase 2 clinical trial that exhibited the efficacy and tolerance of a novel androgen-receptor targeting agent (abiraterone acetate plus prednisone) in patients with prostate cancer who experienced rising prostate-specific antigen after radical prostatectomy, in combination with prostate bed radiotherapy. The results also indicated the feasibility and potential value of circulating tumor cell detection, which constitutes a possible advance in managing prostate cancers.
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Affiliation(s)
- Loic Ah-Thiane
- Department of Radiotherapy, ICO Rene Gauducheau, St-Herblain, France
| | - Loic Campion
- Department of Biostatistics, ICO Rene Gauducheau, St-Herblain, France
| | - Nedjla Allouache
- Department of Radiotherapy, Francois Baclesse Center, Caen, France
| | - Emmanuel Meyer
- Department of Radiotherapy, Francois Baclesse Center, Caen, France
| | - Pascal Pommier
- Department of Radiotherapy, Leon Berard Center, Lyon, France
| | | | | | - Gilles Créhange
- Department of Radiotherapy, Georges Francois Leclerc Center, Dijon, France
| | - Valentine Guimas
- Department of Radiotherapy, ICO Rene Gauducheau, St-Herblain, France
| | - Emmanuel Rio
- Department of Radiotherapy, ICO Rene Gauducheau, St-Herblain, France
| | - Paul Sargos
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | - Sylvain Ladoire
- Department of Radiotherapy, Georges Francois Leclerc Center, Dijon, France
| | | | - Stéphane Supiot
- Department of Radiotherapy, ICO Rene Gauducheau, St-Herblain, France; Inserm UMR1232, CNRS ERL 6001, Nantes University, Nantes, France.
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Adrenal Gland Irradiation Causes Fatigue Accompanied by Reactive Changes in Cortisol Levels. J Clin Med 2022; 11:jcm11051214. [PMID: 35268304 PMCID: PMC8911448 DOI: 10.3390/jcm11051214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidental radiotherapy (RT) to the adrenal gland may have systemic effects. This study aimed to investigate the effects of adrenal RT on fatigue. METHODS BALB/c mice were surgically explored to identify the left adrenal gland and delivered intra-operative RT. The swimming endurance test was used for endurance assessment to represent fatigue. Plasma levels of stress hormones and histopathological features were examined. Three patients with inevitable RT to the adrenal gland were enrolled for the preliminary study. Serum levels of cortisol, aldosterone, and adrenocorticotropic hormone (ACTH) were measured before and after RT. Fatigue score by using the fatigue severity scale and RT dosimetric parameters were collected. RESULTS In the experimental mouse model, adrenal RT decreased baseline cortisol from 274.6 ± 37.8 to 193.6 ± 29.4 ng/mL (p = 0.007) and swimming endurance time from 3.7 ± 0.3 to 1.7 ± 0.6 min (p = 0.02). In histopathological assessment, the irradiated adrenal glands showed RT injury features in the adrenal cortex. In the enrolled patients, baseline cortisol significantly declined after RT. There were no significant differences in the levels of morning cortisol, aldosterone, and ACTH before and after RT. CONCLUSIONS The RT dose distributed to the adrenal gland may correlate with unwanted adverse effects, including fatigue and adrenal hormone alterations.
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Singh J, Sohal SS, Ahuja K, Lim A, Duncan H, Thachil T, De Ieso P. Investigation of circulatory cytokines in patients undergoing intensity-modulated radiotherapy (IMRT) for adenocarcinoma of the prostate and association with acute RT-induced toxicity: A prospective clinical study. Cytokine 2020; 131:155108. [PMID: 32330791 DOI: 10.1016/j.cyto.2020.155108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/29/2020] [Accepted: 04/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Jagtar Singh
- College of Health and Human Sciences, Charles Darwin University, Northern Territory, Australia.
| | | | - Kiran Ahuja
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Aijye Lim
- Department of Anatomical Pathology, Royal Darwin Hospital, Northern Territory, Australia.
| | - Henry Duncan
- Darwin Private Hospital, Royal Darwin Hospital, Northern Territory, Australia.
| | - Thanuja Thachil
- Austin Radiation Oncology Centre, Ballarat, Victoria, Australia.
| | - Paolo De Ieso
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Ade N, Eeden DV, Du Plessis FCP. Dose Shadowing and Prosthesis Involvement for Megavoltage Photon In vivo Diode Dosimetry. J Med Phys 2019; 44:254-262. [PMID: 31908384 PMCID: PMC6936197 DOI: 10.4103/jmp.jmp_59_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/14/2019] [Accepted: 10/08/2019] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of the study is to investigate the photon beam perturbations induced by an in vivo diode in combination with prosthesis involvement in a human-like phantom. MATERIALS AND METHODS Beam perturbations for 6 MV and 10 MV photons caused by an EDP-203G in vivo diode in combination with prosthesis involvement were studied in a unique water-equivalent pelvic phantom, equipped with bony structures and Ti prosthesis using single fields between 2 × 2 and 15 cm × 15 cm as well as 10 MV lateral opposing fields and a four-field plan. Dose distributions were measured with Gafchromic EBT3 films with and without the diode included in the beams on the prosthesis (prosthetic fields) and non-prosthesis (non-prosthetic fields) sides of the phantom. Differences between prosthetic and non-prosthetic field dose data were determined to assess the effect of the prosthesis on the diode-induced beam perturbations inside the phantom. RESULTS Photon beam dose perturbations ranged from 2% to 7% and from 5% to 12% for prosthetic and non-prosthetic fields, respectively, with relative differences between 2% and 4%. In addition, d50 depths ranging from 8.7 to 11.5 cm and from 11.5 to 15 cm were acquired in the phantom for prosthetic and non-prosthetic fields, respectively, with relative differences between 2% and 5%. CONCLUSION On the basis of accuracy requirements in radiotherapy noting that a small underdose to tumors could yield a decrease in the probability of tumor control, the diode-induced beam perturbations in combination with prosthesis involvement in the photon fields may affect treatment outcome, as there would be a reduction in the prescribed target dose during treatment delivery.
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Affiliation(s)
- Nicholas Ade
- Department of Medical Physics, University of the Free State, Bloemfontein, South Africa
| | - Dete Van Eeden
- Department of Medical Physics, University of the Free State, Bloemfontein, South Africa
| | - F. C. P. Du Plessis
- Department of Medical Physics, University of the Free State, Bloemfontein, South Africa
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Bower JE. The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer 2019; 125:353-364. [PMID: 30602059 DOI: 10.1002/cncr.31790] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
Fatigue is a common and distressing symptom in both patients with cancer and cancer survivors. There is substantial variation in the severity and persistence of cancer-related fatigue that may be driven by individual differences in host factors, including characteristics that predate the cancer experience as well as responses to cancer and its treatment. This review examines biobehavioral risk factors linked to fatigue and the mechanisms through which they influence fatigue across the cancer continuum, with a focus on neuro-immune processes. Among psychosocial risk factors, childhood adversity is a strong and consistent predictor of cancer-related fatigue; other risk factors include history of depression, catastrophizing, lack of physical activity, and sleep disturbance, with compelling preliminary evidence for loneliness and trait anxiety. Among biologic systems, initial work suggests that alterations in immune, neuroendocrine, and neural processes are associated with fatigue. The identification of key risk factors and underlying mechanisms is critical for the development and deployment of targeted interventions to reduce the burden of fatigue in the growing population of cancer survivors. Given the multidimensional nature of fatigue, interventions that influence multiple systems may be most effective.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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Supiot S, Campion L, Pommier P, Dore M, Palpacuer C, Racadot S, Rio E, Milano GA, Mahier-Ait Oukhatar C, Carrie C. Combined abiraterone acetate plus prednisone, salvage prostate bed radiotherapy and LH-RH agonists (CARLHA-GEP12) in biochemically-relapsing prostate cancer patients following prostatectomy: A phase I study of the GETUG/GEP. Oncotarget 2018; 9:22147-22157. [PMID: 29774129 PMCID: PMC5955159 DOI: 10.18632/oncotarget.25189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 04/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background To establish the maximum tolerated dose of abiraterone acetate plus prednisone (AA) combined with salvage radiotherapy (SRT) and goserelin in a phase 1 study in men with rising PSA following radical prostatectomy. Methods AA was given during one month before SRT at 1000 mg PO once daily, then 750 mg (Dose Level 1, DL1) or 1000 mg (DL2) during 5 months combined with 6-months goserelin by injection on the first day of irradiation (scheme NEO) or one month before starting SRT (scheme CONCO). Results In scheme NEO at DL1, 2/9 patients did not achieve castration levels of testosterone. 4/9 patients (44%) presented with grade 3 liver enzyme elevation. In scheme CONCO testosterone dropped to undetectable levels. At DL1, 6 patients were recruited, with no dose limiting toxicities. At DL2, 2/3 patients presented with grade 3 liver enzyme elevation occurring during SRT. Conclusions When AA was administered without goserilin, only 78% achieved castration levels. AA combined with SRT and goserilin did not increase pelvic toxicity, but lead to an unsuspected high frequency of grade 3 liver toxicity. The phase II recommended dose of AA combined to goserelin and SRT is 750 mg.
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Affiliation(s)
- Stéphane Supiot
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Loic Campion
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
| | - Mélanie Dore
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Clément Palpacuer
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
| | - Emmanuel Rio
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Gérard A Milano
- Laboratoire d'Oncopharmacologie, Centre Antoine-Lacassagne, Nice, France
| | | | - Christian Carrie
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
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Wong J, Tran LT, Lynch KA, Wood LJ. Dexamethasone exacerbates cytotoxic chemotherapy induced lethargy and weight loss in female tumor free mice. Cancer Biol Ther 2018; 19:87-96. [PMID: 29231783 PMCID: PMC5790388 DOI: 10.1080/15384047.2017.1394549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/15/2017] [Indexed: 02/08/2023] Open
Abstract
Cytotoxic chemotherapy can induce a systemic inflammatory response which has been proposed to be an underlying mechanism of cancer treatment related fatigue. Dexamethasone, a synthetic glucocorticoid that has potent anti-inflammatory effects, is incorporated into chemotherapy regimens to prevent chemotherapy-induced nausea and vomiting (CINV). The purpose of this study was to determine whether by suppressing cytotoxic chemotherapy-induced inflammation, dexamethasone could ameliorate chemotherapy induced fatigue/lethargy in tumor free mice. The effect of dexamethasone (DEX) on Cytoxan-Adriamycin (CA)-induced inflammation was assessed by measuring circulating levels of IL-1β, TNF-α, IL-6, GCSF, KC, and MCP-1 twenty-four-hours post CA injection. Decline in voluntary wheel running activity (VWRA) from baseline (used as a proxy for fatigue/lethargy), body weight and composition, and food intake were monitored in mice administered four cycles of CA every two weeks with or without DEX. CA increased circulating levels of IL-6, GCSF, KC, and MCP-1 and caused a rapid decline in VWRA and body weight immediately following CA-injection. Although the acute CA-induced decline in VWRA and body weight was not evident in mice administered CA + DEX, DEX alone had a suppressive effect on VWRA, and body weight continued to decline in mice administered both CA and DEX while it returned to baseline in CA-treated mice. CA or DEX alone had no long term impact on VWRA but DEX exacerbated lethargy and weight loss in CA-treated mice. Despite dampening the systemic inflammatory response to chemotherapy, dexamethasone failed to ameliorate acute or long term chemotherapy related fatigue/lethargy. Our pre-clinical findings suggest that supportive therapies like dexamethasone used to acutely control nausea and vomiting in cancer patients may actually contribute to overall symptom burden in cancer patients.
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Affiliation(s)
- John Wong
- School of Nursing, MGH Institute of Health Professions, Boston MA, USA
| | - Lisa T. Tran
- School of Nursing, MGH Institute of Health Professions, Boston MA, USA
| | - Kaari A. Lynch
- School of Nursing, MGH Institute of Health Professions, Boston MA, USA
| | - Lisa J. Wood
- School of Nursing, MGH Institute of Health Professions, Boston MA, USA
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Siva S, Lobachevsky P, MacManus MP, Kron T, Möller A, Lobb RJ, Ventura J, Best N, Smith J, Ball D, Martin OA. Radiotherapy for Non–Small Cell Lung Cancer Induces DNA Damage Response in Both Irradiated and Out-of-field Normal Tissues. Clin Cancer Res 2016; 22:4817-4826. [DOI: 10.1158/1078-0432.ccr-16-0138] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022]
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