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Martinussen T, Stensrud MJ. Estimation of separable direct and indirect effects in continuous time. Biometrics 2023; 79:127-139. [PMID: 34506039 DOI: 10.1111/biom.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
Many research questions involve time-to-event outcomes that can be prevented from occurring due to competing events. In these settings, we must be careful about the causal interpretation of classical statistical estimands. In particular, estimands on the hazard scale, such as ratios of cause-specific or subdistribution hazards, are fundamentally hard to interpret causally. Estimands on the risk scale, such as contrasts of cumulative incidence functions, do have a clear causal interpretation, but they only capture the total effect of the treatment on the event of interest; that is, effects both through and outside of the competing event. To disentangle causal treatment effects on the event of interest and competing events, the separable direct and indirect effects were recently introduced. Here we provide new results on the estimation of direct and indirect separable effects in continuous time. In particular, we derive the nonparametric influence function in continuous time and use it to construct an estimator that has certain robustness properties. We also propose a simple estimator based on semiparametric models for the two cause-specific hazard functions. We describe the asymptotic properties of these estimators and present results from simulation studies, suggesting that the estimators behave satisfactorily in finite samples. Finally, we reanalyze the prostate cancer trial from Stensrud et al. (2020).
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Affiliation(s)
| | - Mats Julius Stensrud
- Department of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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2
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Seidi F, Zhong Y, Xiao H, Jin Y, Crespy D. Degradable polyprodrugs: design and therapeutic efficiency. Chem Soc Rev 2022; 51:6652-6703. [PMID: 35796314 DOI: 10.1039/d2cs00099g] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Prodrugs are developed to increase the therapeutic properties of drugs and reduce their side effects. Polyprodrugs emerged as highly efficient prodrugs produced by the polymerization of one or several drug monomers. Polyprodrugs can be gradually degraded to release therapeutic agents. The complete degradation of polyprodrugs is an important factor to guarantee the successful disposal of the drug delivery system from the body. The degradation of polyprodrugs and release rate of the drugs can be controlled by the type of covalent bonds linking the monomer drug units in the polymer structure. Therefore, various types of polyprodrugs have been developed based on polyesters, polyanhydrides, polycarbonates, polyurethanes, polyamides, polyketals, polymetallodrugs, polyphosphazenes, and polyimines. Furthermore, the presence of stimuli-responsive groups, such as redox-responsive linkages (disulfide, boronate ester, metal-complex, and oxalate), pH-responsive linkages (ester, imine, hydrazone, acetal, orthoester, P-O and P-N), light-responsive (metal-complex, o-nitrophenyl groups) and enzyme-responsive linkages (ester, peptides) allow for a selective degradation of the polymer backbone in targeted tumors. We envision that new strategies providing a more efficient synergistic therapy will be developed by combining polyprodrugs with gene delivery segments and targeting moieties.
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Affiliation(s)
- Farzad Seidi
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China. .,Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand.
| | - Yajie Zhong
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China.
| | - Huining Xiao
- Department of Chemical Engineering, University of New Brunswick, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Yongcan Jin
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources and International Innovation Center for Forest Chemicals and Materials, Nanjing Forestry University, Nanjing 210037, China.
| | - Daniel Crespy
- Department of Materials Science and Engineering, School of Molecular Science and Engineering, Vidyasirimedhi Institute of Science and Technology (VISTEC), Rayong 21210, Thailand.
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Stensrud MJ, Hernán MA, Tchetgen Tchetgen EJ, Robins JM, Didelez V, Young JG. A generalized theory of separable effects in competing event settings. LIFETIME DATA ANALYSIS 2021; 27:588-631. [PMID: 34468923 PMCID: PMC8536652 DOI: 10.1007/s10985-021-09530-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/16/2021] [Indexed: 05/04/2023]
Abstract
In competing event settings, a counterfactual contrast of cause-specific cumulative incidences quantifies the total causal effect of a treatment on the event of interest. However, effects of treatment on the competing event may indirectly contribute to this total effect, complicating its interpretation. We previously proposed the separable effects to define direct and indirect effects of the treatment on the event of interest. This definition was given in a simple setting, where the treatment was decomposed into two components acting along two separate causal pathways. Here we generalize the notion of separable effects, allowing for interpretation, identification and estimation in a wide variety of settings. We propose and discuss a definition of separable effects that is applicable to general time-varying structures, where the separable effects can still be meaningfully interpreted as effects of modified treatments, even when they cannot be regarded as direct and indirect effects. For these settings we derive weaker conditions for identification of separable effects in studies where decomposed, or otherwise modified, treatments are not yet available; in particular, these conditions allow for time-varying common causes of the event of interest, the competing events and loss to follow-up. We also propose semi-parametric weighted estimators that are straightforward to implement. We stress that unlike previous definitions of direct and indirect effects, the separable effects can be subject to empirical scrutiny in future studies.
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Affiliation(s)
- Mats J Stensrud
- Department of Mathematics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, USA
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - James M Robins
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, USA
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Vanessa Didelez
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Mathematics/Computer Science, University of Bremen, Bremen, Germany
| | - Jessica G Young
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
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Estetrol Cotreatment of Androgen Deprivation Therapy in Infiltrating or Metastatic, Castration-sensitive Prostate Cancer: A Randomized, Double-blind, Phase II Trial (PCombi). EUR UROL SUPPL 2021; 28:52-61. [PMID: 34337526 PMCID: PMC8317802 DOI: 10.1016/j.euros.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) for prostate cancer with luteinizing hormone-releasing hormone (LHRH) agonists can be improved. Objective To assess safety, the frequency and severity of hot flushes (HFs), bone health, and antitumor effects of high-dose estetrol (HDE4) when combined with ADT. Design, setting and participants A phase II, double-blind, randomized, placebo-controlled study was conducted in advanced prostate cancer patients requiring ADT (the PCombi study). Intervention Patients receiving LHRH agonist treatment were randomized 2:1 to 40 mg HDE4 (n = 41) or placebo (n = 21) cotreatment for 24 wk. Outcome measurements and statistical analysis Coprimary endpoints were frequency/severity of HFs and levels of total and free testosterone (T). Secondary endpoints included assessments of bone metabolism (osteocalcin and type I collagen telopeptide [CTX1]), prostate-specific antigen (PSA), and follicle-stimulating hormone (FSH). Efficacy analysis was based on the selected per-protocol (PP) population. Results and limitations Of 62 patients included in the study, 57 were suitable for a PP analysis (37 HDE4; 20 placebo). No E4-related serious cardiovascular adverse events occurred at 24 wk. Weekly HFs were reported by 13.5% of patients with HDE4 and 60.0% with placebo (p < 0.001). Daily HFs occurred in 5.9% versus 55%. Bone turnover parameters decreased significantly with HDE4 (p < 0.0001). Total and free T decreased earlier (p < 0.05), and free T was suppressed further (p < 0.05). PSA suppression was more profound and earlier (p < 0.005). FSH levels were suppressed by 98% versus 57% (p < 0.0001). Estrogenic side effects were nipple sensitivity (34%) and gynecomastia (17%). Conclusions HDE4 cotreatment of ADT patients with advanced prostate cancer was well tolerated, and no treatment-related cardiovascular adverse events were observed at 24 wk. HFs and bone turnover were substantially reduced. Suppression of free T, PSA, and FSH was more rapid and profound, suggesting enhanced disease control by HDE4 cotreatment. Larger and longer-lasting studies are needed to confirm the results of the study reported here. Patient summary Cotreatment of androgen deprivation therapy with high-dose estetrol in advanced prostate cancer patients results in fewer occurrences of hot flushes, bone protection, and other antitumor benefits. Nipple sensitivity and gynecomastia may occur as side effects.
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Mohler JL, Antonarakis ES, Armstrong AJ, D'Amico AV, Davis BJ, Dorff T, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Ippolito JE, Kane CJ, Kuettel MR, Lang JM, McKenney J, Netto G, Penson DF, Plimack ER, Pow-Sang JM, Pugh TJ, Richey S, Roach M, Rosenfeld S, Schaeffer E, Shabsigh A, Small EJ, Spratt DE, Srinivas S, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:479-505. [PMID: 31085757 DOI: 10.6004/jnccn.2019.0023] [Citation(s) in RCA: 837] [Impact Index Per Article: 209.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joseph E Ippolito
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jesse McKenney
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - George Netto
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Sylvia Richey
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Edward Schaeffer
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Shabsigh
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Eric J Small
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Jonathan Tward
- Huntsman Cancer Institute at the University of Utah; and
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Stensrud MJ, Young JG, Didelez V, Robins JM, Hernán MA. Separable Effects for Causal Inference in the Presence of Competing Events. J Am Stat Assoc 2020. [DOI: 10.1080/01621459.2020.1765783] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mats J. Stensrud
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Jessica G. Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Vanessa Didelez
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Mathematics/Computer Science, University of Bremen, Bremen, Germany
| | - James M. Robins
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Miguel A. Hernán
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA
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7
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Untangling the association between environmental endocrine disruptive chemicals and the etiology of male genitourinary cancers. Biochem Pharmacol 2019; 172:113743. [PMID: 31812676 DOI: 10.1016/j.bcp.2019.113743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
Endocrine disrupting chemicals disrupt normal physiological function of endogenous hormones, their receptors, and signaling pathways of the endocrine system. Most endocrine disrupting chemicals exhibit estrogen/androgen agonistic and antagonistic activities that impinge upon hormone receptors and related pathways. Humans are exposed to endocrine disrupting chemicals through food, water and air, affecting the synthesis, release, transport, metabolism, binding, function and elimination of naturally occurring hormones. The urogenital organs function as sources of steroid hormones, are targeted end organs, and participate within systemic feedback loops within the endocrine system. The effects of endocrine disruptors can ultimately alter cellular homeostasis leading to a broad range of health effects, including malignancy. Human cancer is characterized by uncontrolled cell proliferation, mechanisms opposing cell-death, development of immortality, induction of angiogenesis, and promotion of invasion/metastasis. While hormonal malignancies of the male genitourinary organs are the second most common types of cancer, the molecular effects of endocrine disrupting chemicals in hormone-driven cancers has yet to be fully explored. In this commentary, we examine the molecular evidence for the involvement of endocrine disrupting chemicals in the genesis and progression of hormone-driven cancers in the prostate, testes, and bladder. We also report on challenges that have to be overcome to drive our understanding of these chemicals and explore the potential avenues of discovery that could ultimately allow the development of tools to prevent cancer in populations where exposure is inevitable.
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Radaelli E, Santagostino SF, Sellers RS, Brayton CF. Immune Relevant and Immune Deficient Mice: Options and Opportunities in Translational Research. ILAR J 2019; 59:211-246. [PMID: 31197363 PMCID: PMC7114723 DOI: 10.1093/ilar/ily026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/03/2018] [Indexed: 12/29/2022] Open
Abstract
In 1989 ILAR published a list and description of immunodeficient rodents used in research. Since then, advances in understanding of molecular mechanisms; recognition of genetic, epigenetic microbial, and other influences on immunity; and capabilities in manipulating genomes and microbiomes have increased options and opportunities for selecting mice and designing studies to answer important mechanistic and therapeutic questions. Despite numerous scientific breakthroughs that have benefitted from research in mice, there is debate about the relevance and predictive or translational value of research in mice. Reproducibility of results obtained from mice and other research models also is a well-publicized concern. This review summarizes resources to inform the selection and use of immune relevant mouse strains and stocks, aiming to improve the utility, validity, and reproducibility of research in mice. Immune sufficient genetic variations, immune relevant spontaneous mutations, immunodeficient and autoimmune phenotypes, and selected induced conditions are emphasized.
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Affiliation(s)
- Enrico Radaelli
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara F Santagostino
- Department of Safety Assessment, Genentech, Inc., South San Francisco, California
| | | | - Cory F Brayton
- Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Moorthy HK, Laxman Prabhu GG, Venugopal P. The resurgence of estrogens in the treatment of castration-resistant prostate cancer. Indian J Urol 2019; 35:189-196. [PMID: 31367069 PMCID: PMC6639989 DOI: 10.4103/iju.iju_56_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Use of exogenous estrogens in manipulating the androgenestrogen equilibrium was one of the earliest therapeutic strategies developed to treat prostate cancer which followed close on heels the discovery of hormone dependence of this tumor. Despite its well-documented benefit, estrogen therapy fell out of favor with the advent of other forms of androgen deprivation therapy (ADT) as the former registered a higher incidence of cardiovascular complications and poorer overall survival. Clearer understanding of the mechanism of action of estrogen coupled with the adoption of alternative routes of administration has triggered a renewed interest in estrogen therapy. Since then, many studies have not only proved the therapeutic benefit of estrogens but also explored the ways and means of minimizing the dreaded side effects deterring its use. Further, the fact that estrogen therapy offered a clear advantage of reduced cost of treatment over other treatments has led many countries to readopt it in the treatment of advanced prostatic cancer. We reviewed the published data on the use of estrogens in CRPC, which may affect its revival as an efficacious treatment option having minimal side effects, with modified dosage and route of administration. Estrogen therapy would be a less expensive option having equivalent or even better therapeutic effect than ADT in advanced carcinoma of prostate.
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Affiliation(s)
| | - G G Laxman Prabhu
- Department of Urology, Kasturba Medical College (A Unit of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - P Venugopal
- Department of Urology, Kasturba Medical College (A Unit of Manipal Academy of Higher Education), Mangalore, Karnataka, India
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Schreiber E, Alfageme O, Garcia T, González N, Sirvent JJ, Torrente M, Gómez M, Domingo JL. Oral exposure of rats to dienestrol during gestation and lactation: Effects on the reproductive system of male offspring. Food Chem Toxicol 2019; 128:193-201. [PMID: 30986439 DOI: 10.1016/j.fct.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/21/2022]
Abstract
This study was aimed at determining whether dienestrol (DIES) affects reproduction in male offspring of rats following oral maternal exposure during gestation and lactation. Pregnant rats were treated from GD 6 to PND 21. Animals received 0 (control-vehicle), 0.75, 1.5, 3.12, 6.25, 12.5, 50, 75 μg/kg bw/d of DIES. A control group -without vehicle-was also included. High DIES concentrations caused abortions at 75 and 50 μg/kg bw/d, while at 12.5 μg/kg bw/d had still miscarriages. Ten male rats per group were kept alive until PND 90 to ensure sexual maturity. Body and organ weights, anogenital distance (AGD) at PNDs 21 and 90, biochemical and sperm parameters like motility, viability, morphology, spermatozoa and resistant spermatid counts, and histopathology for sexual organs and liver were determined. An increase in organ weight (liver and sexual organs) and a decrease in AGD due to vehicle were found. A reduction of sperm motility and viability, and an increase of abnormal sperm morphology were caused by DIES, which provoked a dose-dependent prostatitis. Maternal exposure to DIES induced toxicity on the reproductive system of the male offspring, which could affect the capacity of fertilization.
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Affiliation(s)
- Elga Schreiber
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Oscar Alfageme
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Tania Garcia
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Neus González
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - Juan José Sirvent
- Department of Pathology, University Hospital Joan XXIII, Tarragona, Catalonia, Spain
| | - Margarita Torrente
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain; Research Center in Behavioral Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
| | - Mercedes Gómez
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain
| | - José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Reus, Catalonia, Spain.
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Coelingh Bennink HJT, Zimmerman Y, Verhoeven C, Dutman AE, Mensinga T, Kluft C, Reisman Y, Debruyne FMJ. A Dose-Escalating Study With the Fetal Estrogen Estetrol in Healthy Men. J Clin Endocrinol Metab 2018; 103:3239-3249. [PMID: 29931320 DOI: 10.1210/jc.2018-00147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Luteinizing hormone-releasing hormone (LHRH) agonists have replaced estrogens for endocrine treatment of advanced prostate cancer (PC) because of cardiovascular side effects. The fetal estrogen estetrol (E4) may be safer for PC treatment and is expected to decrease testosterone (T) and prevent estrogen deficiency. OBJECTIVE To investigate the safety and T-suppressive effect of E4 in healthy men. DESIGN Double-blind, randomized, placebo-controlled, dose-escalating study. SETTING The study was conducted at a phase I clinical unit (QPS, Netherlands). PARTICIPANTS Healthy male volunteers aged 40 to 70 years. INTERVENTION(S) Three treatment cohorts of 15 volunteers with placebo (n = 5) and E4 (n = 10). Estetrol doses tested were 20, 40, and 60 mg/d. Subjects were treated for 4 weeks. MAIN OUTCOME MEASURES Subjective side effects, pharmacodynamic effects on hemostatic variables, lipids, glucose, bone parameters, and endocrine parameters related to T metabolism. RESULTS Total and free T decreased dose-dependently and significantly. Nipple tenderness occurred in 40% and decrease of libido occurred in 30% of E4-treated men. The unwanted estrogenic effects on hemostasis were small, dose dependent, and in some cases significant. Lipid and bone parameters showed a favorable trend. CONCLUSION The effect of E4 on testosterone levels is insufficient for standalone PC treatment. Taking all clinical and pharmacodynamic variables into consideration, a daily dose of 40 mg E4 seems safe for further evaluation of endocrine PC treatment in combination with LHRH analogs.
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Affiliation(s)
| | | | | | | | | | | | - Yacov Reisman
- Department of Urology, Amstelland Hospital, AM Amstelveen, Netherlands
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12
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Estrogens and prostate cancer. Prostate Cancer Prostatic Dis 2018; 22:185-194. [PMID: 30131606 DOI: 10.1038/s41391-018-0081-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/30/2018] [Accepted: 07/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hormonal influences such as androgens and estrogens are known contributors in the development and progression of prostate cancer (CaP). While much of the research to the hormonal nature of CaP has focused on androgens, estrogens also have critical roles in CaP development, physiology as well as a potential therapeutic intervention. METHODS In this review, we provide a critical literature review of the current basic science and clinical evidence for the interaction between estrogens and CaP. RESULTS Estrogenic influences in CaP include synthetic, endogenous, fungi and plant-derived compounds, and represent a family of sex hormones, which cross hydrophobic cell membranes and bind to membrane-associated receptors and estrogen receptors that localize to the nucleus triggering changes in gene expression in various organ systems. CONCLUSIONS Estrogens represent a under-recognized contributor in CaP development and progression. Further research in this topic may provide opportunities for identification of environmental influencers as well as providing novel therapeutic targets in the treatment of CaP.
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Condappa A, Gossell-Williams M, Aiken W. Favourable response of serum prostate-specific antigen to conjugated oestrogen in castrate-resistant prostate cancer in Jamaica. Ecancermedicalscience 2018; 12:829. [PMID: 29743949 PMCID: PMC5931810 DOI: 10.3332/ecancer.2018.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Indexed: 11/06/2022] Open
Abstract
Conjugated oestrogen is one of the more affordable secondary hormonal options available for castrate-resistant prostate cancer (CRPC) in Jamaica. The present study was conducted to examine the disease response in Jamaican men with CRPC treated with conjugated oestrogen. This study retrospectively reviewed the medical notes of patients who attended the urologic clinic of the University Hospital of the West Indies from 1 January 2009 to 31 December 2013 and a private urology clinic from 2 November 2005 to 3 June 2015 to identify patients diagnosed with CRPC treated with conjugated oestrogen (Premarin ®) as secondary therapy. The primary endpoint of favourable response, using the Prostate Cancer Clinical Trials Working Group 2 criteria is a decline of ≥50% in serum prostate-specific antigen (PSA) concentrations from baseline after treatment. The proportion of patients responding by the first 3-month follow-up visit and the maximal PSA declined over the 24 months of follow-up which were recorded. Thirty-two patients diagnosed with CRPC and treated with conjugated oestrogen were identified. All patients were prescribed 5.0 mg (2.5 mg tablets, twice daily) orally, as well as low dose aspirin. Favourable response was observed in 14 (43.8%) patients; however, eight other patients showed a decline in serum PSA concentration of <50%. There were no reported adverse effects. Conjugated oestrogen produced a PSA decline in Jamaican CRPC patients of this study and may therefore be a useful option for secondary therapy of CRPC. Further assessment is needed.
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Affiliation(s)
- Andrew Condappa
- Department of Basic Medical Sciences, University of the West Indies, Kingston, Jamaica
| | | | - William Aiken
- Department of Surgery, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
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Poon DMC, Chan CK, Chan TW, Cheung FY, Kwong PWK, Lee EKC, Leung AKC, Leung SYL, Ma WK, So HS, Tam PC, Ho LY. Consensus statements on the management of metastatic prostate cancer from the Hong Kong Urological Association and Hong Kong Society of Uro-Oncology. BJU Int 2018; 121:703-715. [DOI: 10.1111/bju.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Darren Ming-Chun Poon
- Department of Clinical Oncology; State Key Laboratory in Oncology in South China; Sir YK Pao Centre for Cancer; Hong Kong Cancer Institute and Prince of Wales Hospital; Chinese University of Hong Kong; Hong Kong Hong Kong
| | - Chi-Kwok Chan
- Department of Surgery; Prince of Wales Hospital; Hong Kong Hong Kong
| | - Tim-Wai Chan
- Department of Clinical Oncology; Queen Elizabeth Hospital; Hong Kong Hong Kong
| | | | | | - Eric Ka-Chai Lee
- Department of Clinical Oncology; Tuen Mun Hospital; Hong Kong Hong Kong
| | | | | | - Wai-Kit Ma
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
| | - Hing-Shing So
- Division of Urology; Department of Surgery; United Christian Hospital; Hong Kong Hong Kong
| | - Po-Chor Tam
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
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Polotti CF, Kim CJ, Chuchvara N, Polotti AB, Singer EA, Elsamra S. Androgen deprivation therapy for the treatment of prostate cancer: a focus on pharmacokinetics. Expert Opin Drug Metab Toxicol 2017; 13:1265-1273. [PMID: 29137489 DOI: 10.1080/17425255.2017.1405934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Medical therapy has undergone many changes as our understanding of prostate cancer cell biology has improved. Androgen deprivation therapy (ADT) remains the mainstay of therapy for metastatic disease. Metastatic castrate-resistant prostate cancer (CRPC) is an important concern since we are unable to stop progression with currently available agents. Areas covered: Pharmacologic ADT is the most commonly used treatment for metastatic prostate cancer. Multiple agents are available for both first-line and second-line use: antiandrogens, estrogens, luteinizing hormone-releasing hormone agonists/antagonists, and CYP17 inhibitors. With adoption of these drugs, it is important to consider their pharmacokinetic and pharmacodynamic properties. Many undergo metabolism through cytochrome P450. Levels may be altered with co-administration of drugs acting as enzyme inhibitors or inducers. Understanding mechanism of action, metabolism, and excretion of these drugs allows clinicians to provide the best therapeutic care while minimizing adverse events. Expert opinion: Many men with metastatic prostate cancer will progress to castration resistance. An understanding of resistance mechanisms at the cellular level has revealed new drug targets with hopes of halting or reversing progression of metastatic disease. Second-line agents, traditionally reserved for CRPC, are being studied in metastatic castrate-sensitive prostate cancer, and may offer practice-changing evidence supporting their use.
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Affiliation(s)
- Charles F Polotti
- a Division of Urology , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Christopher J Kim
- a Division of Urology , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Nadiya Chuchvara
- a Division of Urology , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Alyssa B Polotti
- b Department of Pharmacy Practice and Pharmacy Administration , University of the Sciences, Philadelphia College of Pharmacy , Philadelphia , PA , USA
| | - Eric A Singer
- c Section of Urologic Oncology , Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Sammy Elsamra
- a Division of Urology , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA.,c Section of Urologic Oncology , Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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16
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Moharrami P, Unak P, Guldu OK, Medine Eİ, Gumuser G, Bilgin ES, Aras O. Multifunctional molecular imaging probes for estrogen receptors: 99mTc labeled diethylstilbestrol (DES) conjugated, cuinp quantum dot nanoparticles (DESCIP). J Radioanal Nucl Chem 2017. [DOI: 10.1007/s10967-017-5630-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Kaipia A, Visapää H. The complex interplay of sex steroids manifested by endocrine treatment of prostate cancer. Scand J Urol 2017; 51:206-211. [PMID: 28657385 DOI: 10.1080/21681805.2017.1329901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antti Kaipia
- a Satakunta Central Hospital , Department of Surgery , Pori , Finland
| | - Harri Visapää
- b Helsinki University Central Hospital , Departments of Urology and Oncology , Helsinki , Finland
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18
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Synthesis and Antitumor Activity of Novel Pyridoxine-Based Bioisosteric Analogs of trans-Stilbenes. J CHEM-NY 2017. [DOI: 10.1155/2017/8281518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A series of trans-6-phenylethenyl substituted pyridoxine derivatives, novel bioisosteric analogs of drugs based on trans-stilbene scaffold, were synthesized using the Wittig reaction of a bis-triphenylphosphonium pyridoxine derivative with various aromatic aldehydes. Two compounds demonstrated high activity against the estrogen-dependent MCF-7 (breast cancer) cell line with IC50 in the range of 1.9–7.9 µM and very good selectivity for other studied normal and tumor cells, including the estrogen receptor negative MDA-MB-231 breast cancer cells. The active compounds possessed an intense blue fluorescence, and this feature allowed us to effectively visualize them in cytoplasm and in nucleus. The obtained results make the described chemotype a promising starting point for the development of new anticancer agents for the therapy of estrogen-dependent malignancies.
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Höcherl A, Jäger E, Jäger A, Hrubý M, Konefał R, Janoušková O, Spěváček J, Jiang Y, Schmidt PW, Lodge TP, Štěpánek P. One-pot synthesis of reactive oxygen species (ROS)-self-immolative polyoxalate prodrug nanoparticles for hormone dependent cancer therapy with minimized side effects. Polym Chem 2017. [DOI: 10.1039/c7py00270j] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
One-pot synthesis of ROS-self-immolative polyoxalate prodrug NPs for cancer therapy.
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Affiliation(s)
- Anita Höcherl
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Eliézer Jäger
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Alessandro Jäger
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Martin Hrubý
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Rafał Konefał
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Olga Janoušková
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Jiří Spěváček
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
| | - Yaming Jiang
- Department of Chemistry
- University of Minnesota
- Minneapolis
- USA
| | | | | | - Petr Štěpánek
- Institute of Macromolecular Chemistry v.v.i
- Academy of Sciences of the Czech Republic
- 162 06 Prague 6
- Czech Republic
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20
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Langley RE, Kynaston HG, Alhasso AA, Duong T, Paez EM, Jovic G, Scrase CD, Robertson A, Cafferty F, Welland A, Carpenter R, Honeyfield L, Abel RL, Stone M, Parmar MKB, Abel PD. A Randomised Comparison Evaluating Changes in Bone Mineral Density in Advanced Prostate Cancer: Luteinising Hormone-releasing Hormone Agonists Versus Transdermal Oestradiol. Eur Urol 2015; 69:1016-25. [PMID: 26707868 PMCID: PMC4854173 DOI: 10.1016/j.eururo.2015.11.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/27/2015] [Indexed: 01/09/2023]
Abstract
Background Luteinising hormone-releasing hormone agonists (LHRHa), used as androgen deprivation therapy (ADT) in prostate cancer (PCa) management, reduce serum oestradiol as well as testosterone, causing bone mineral density (BMD) loss. Transdermal oestradiol is a potential alternative to LHRHa. Objective To compare BMD change in men receiving either LHRHa or oestradiol patches (OP). Design, setting, and participants Men with locally advanced or metastatic PCa participating in the randomised UK Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) trial (allocation ratio of 1:2 for LHRHa:OP, 2006–2011; 1:1, thereafter) were recruited into a BMD study (2006–2012). Dual-energy x-ray absorptiometry scans were performed at baseline, 1 yr, and 2 yr. Interventions LHRHa as per local practice, OP (FemSeven 100 μg/24 h patches). Outcome measurements and statistical analysis The primary outcome was 1-yr change in lumbar spine (LS) BMD from baseline compared between randomised arms using analysis of covariance. Results and limitations A total of 74 eligible men (LHRHa 28, OP 46) participated from seven centres. Baseline clinical characteristics and 3-mo castration rates (testosterone ≤1.7 nmol/l, LHRHa 96% [26 of 27], OP 96% [43 of 45]) were similar between arms. Mean 1-yr change in LS BMD was −0.021 g/cm3 for patients randomised to the LHRHa arm (mean percentage change −1.4%) and +0.069 g/cm3 for the OP arm (+6.0%; p < 0.001). Similar patterns were seen in hip and total body measurements. The largest difference between arms was at 2 yr for those remaining on allocated treatment only: LS BMD mean percentage change LHRHa −3.0% and OP +7.9% (p < 0.001). Conclusions Transdermal oestradiol as a single agent produces castration levels of testosterone while mitigating BMD loss. These early data provide further supporting evidence for the ongoing phase 3 trial. Patient summary This study found that prostate cancer patients treated with transdermal oestradiol for hormonal therapy did not experience the loss in bone mineral density seen with luteinising hormone-releasing hormone agonists. Other clinical outcomes for this treatment approach are being evaluated in the ongoing PATCH trial. Trial registration ISRCTN70406718, PATCH trial (ClinicalTrials.gov NCT00303784).
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Affiliation(s)
- Ruth E Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
| | | | | | - Trinh Duong
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Gordana Jovic
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | - Fay Cafferty
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Andrew Welland
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Robin Carpenter
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | | | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Paul D Abel
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK
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Fujimura T, Takahashi S, Kume H, Urano T, Takayama K, Yamada Y, Suzuki M, Fukuhara H, Nakagawa T, Inoue S, Homma Y. Toremifene, a selective estrogen receptor modulator, significantly improved biochemical recurrence in bone metastatic prostate cancer: a randomized controlled phase II a trial. BMC Cancer 2015; 15:836. [PMID: 26526623 PMCID: PMC4630884 DOI: 10.1186/s12885-015-1871-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Durability of androgen-deprivation therapy (ADT) for prostate cancer (PC) is limited. Additional selective estrogen receptor modulators (SERMs) may prolong the durability of ADT, because androgen and estrogen signaling drive PC progression. METHODS Men with treatment-naïve bone metastatic PC were randomly assigned in 1:1:1 fashion to receive ADT, toremifene 60 mg plus ADT (TOPADT), or raloxifene 60 mg plus ADT (RAPADT). The primary endpoint was the biochemical recurrence (BCR) rate, and secondary endpoints were changes of scores of the visual analogue scale (VAS) and the functional assessment of cancer therapy (FACT). RESULTS A total of 15 men, 5 each, were allocated to one of the three treatment arms. The basal serum prostate-specific antigen (PSA) level was 198 ng/mL (median, range; 30-8428). Bone metastases were graded as 1 (n = 11), 2 (n = 3), and 3 (n = 1) by the extent of disease. During the median follow-up period of 1370 days (range; 431-1983), BCR occurred in 3, 0 and 2 men in ADT, TOPADT and RAPADT group, respectively. The 5-year BCR-free rate was 30, 100 and 53 %, in ADT, TOPADT and RAPADT group, respectively (p = 0.04, ADT v.s. TOPADT, p = 0.48, ADT v.s. RAPADT and p = 0.12, TOPADT v.s. RAPADT). Scores of VAS improved in all groups and remained stable throughout the study. This analysis is limited as a preliminary result in a single center. CONCLUSIONS Toremifene with conventional ADT significantly improved the BCR rate in treatment-naïve bone metastatic PC. Further clinical trials are warranted to confirm the promising clinical efficacy of this combination therapy. TRIAL REGISTRATION The protocol was registered at the University Hospital Medical Information Network ( UMIN ID;0,000,064,000 ) in Sep 25, 2011.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Satoru Takahashi
- Department of Urology, Graduate School of Medicine, The Nihon University, Tokyo, Japan.
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomohiko Urano
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Anti-Aging Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kenichi Takayama
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Anti-Aging Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Satoshi Inoue
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Anti-Aging Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Wilson HCP, Shah SIA, Abel PD, Price P, Honeyfield L, Edwards S, Abel RL. Contemporary hormone therapy with LHRH agonists for prostate cancer: avoiding osteoporosis and fracture. Cent European J Urol 2015; 68:165-8. [PMID: 26251735 PMCID: PMC4526606 DOI: 10.5173/ceju.2015.513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction Prostate cancer is a large clinical burden across Europe. It is, in fact, the most common cancer in males, accounting for more than 92,300 deaths annually throughout the continent. Prostate cancer is androgen-sensitive; thus an androgen deprivation therapy (ADT) is often used for treatment by reducing androgen to castrate levels. Several ADT agents have achieved benefits with effective palliation, but, unfortunately, severe adverse events are frequent. Contemporary ADT (Luteinising Hormone Releasing Hormone agonist - LHRHa injections) can result in side effects that include osteoporosis and fractures, compromising quality of life and survival. Methods In this review we analysed the associated bone toxicity consequent upon contemporary ADT and based on the literature and our own experience we present future perspectives that seek to mitigate this associated toxicity both by development of novel therapies and by better identification and prediction of fracture risk. Results Preliminary results indicate that parenteral oestrogen can mitigate associated osteoporotic risk and that CT scans could provide a more accurate indicator of overall bone quality and hence fracture risk. Conclusions As healthcare costs increase globally, cheap and effective alternatives that achieve ADT, but mitigate or avoid such bone toxicities, will be needed. More so, innovative techniques to improve both the measurement and the extent of this toxicity, by assessing bone health and prediction of fracture risk, are also required.
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Affiliation(s)
| | - Syed I A Shah
- Department of Surgery and Cancer, Imperial College, London
| | - Paul D Abel
- Department of Surgery and Cancer, Imperial College, London
| | - Patricia Price
- Department of Surgery and Cancer, Imperial College, London
| | | | - Steve Edwards
- Department of Surgery and Cancer, Imperial College, London
| | - Richard L Abel
- Department of Surgery and Cancer, Imperial College, London
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Shah SIA, Abel PD, Duong T, Price P, Langley R. Parenteral oestrogen: effective and safer than both oral oestrogen and contemporary androgen deprivation therapy for prostate cancer? Scand J Urol 2014; 48:411-2. [PMID: 24882276 DOI: 10.3109/21681805.2014.925500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Syed I A Shah
- Department of Surgery and Cancer, Imperial College Faculty of Medicine , London , UK , and
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