ASCO issues new guidelines on treatment of metastatic prostate cancer

New guidelines on the management of metastatic, hormone-sensitive prostate cancer have just been released by the American Society for Clinical Oncology (ASCO), based primarily on data from the CHAARTED, STAMPEDE, and LATITUDE trial data.

The full text of these new guidelines, developed by Morris et al., is available on line in the Journal of Clinical Oncology and also on the ASCO web site.

The fundamental recommendations of this new set of guidelines are as follows:

  • Standard forms of androgen deprivation therapy (ADT) + either docetaxel or abiraterone acetate (Zytiga) offer a survival benefit as compared with ADT alone for men with newly diagnosed, hormone-sensitive, metastatic prostate cancer .
  • The best evidence of benefit from ADT + docetaxel is in men with newly diagnosed, high-volume, metastatic disease (based on the CHAARTED criteria).
  • Comparable survival benefits are seen based on treatment with ADT + abiraterone acetate in
    • High-risk patients (based on the LATITUDE criteria)
    • The metastatic patients in the STAMPEDE trial.
  • Fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be considered in any decision wbout which of these two types of treatment is appropriate for a specific patient.

The “New” Prostate Cancer InfoLink would bring three additional and important factors to the attention of patients who are considering the initiation of treatment for so-called “de novo” metastatic, hormone-sensitive prostate cancer:

  • ADT + abiraterone acetate requires concurrent, long-term treatment with a corticosteroid such as prednisone or prednisolone. Conticosteroid therapy comes with its own set of potential complications and side effects that should be discussed with one’s doctor prior to making any decision about “the best” way to have your specific condition treated.
  • There has been no direct comparison of ADT + docetaxel chemotherapy to ADT + abiraterone acetate. Consequently, we have no idea whether one of these forms of therapy may be “better” or less risky than the other.
  • It may well be that some patients will gain greater benefit from “first-line” ADT + docetaxel whereas other men may gain greater benefit from “first-line” ADT + abiraterone acetate, but it will likely take a while to see if that is the case.

2 Responses

  1. Since the corticosteroid/steroid prednisone is mentioned when prescribed abiraterone acetate/Zytiga (and is to be taken as one 5 mg tablet twice daily), thought it reasonable to report that a different corticosteroid, dexamethasone, has also been found to be just as effective and only requires one 0.5 mg tablet taken daily to accompany Zytiga.

    This first reference mentions prednisolone accompanying Zytiga though the effects of prednisolone and prednisone are generally the same.

    This next reference specifically mentions the similarity of effect between prednisone and dexamethasone accompanying abiraterone acetate but includes that distinction of only one 0.5 mg of dexamethasone as opposed to requiring two 5 mg doses of prednisone.

    Thus only requiring a single 0.5 mg dose of dexamethasone once daily may be the medication preferred to accompany Zytiga as a cost saver since it is found to be just as effective as prednisone or prednisolone. In any event, worthy of discussion with one’s treating physician.

  2. Chuck:

    The reason that the dose of dexamethasone that can be used is so much lower than the dose of prednisone is that it is a much more powerful form of corticosteroid than prednisone and can have much worse side effects. I think the way to think about this is that one could use either prednisone/prednisolone or dexamethasone at the lowest appropriate dose levels, but any form of long-term corticosteroid therapy is potentially problematic.

    From a cost perspective, both prednisone/prednisolone and dexamethasone are widely available generic drugs. Their cost is minimal.

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