Re: Intense androgen-deprivation therapy with abiraterone acetate plus leuprolide acetate in patients with localized high-risk prostate cancer: results of a randomized phase II neoadjuvant study.
نویسنده
چکیده
PURPOSE Cure rates for localized high-risk prostate cancers (PCa) and some intermediate-risk PCa are frequently suboptimal with local therapy. Outcomes are improved by concomitant androgen-deprivation therapy (ADT) with radiation therapy, but not by concomitant ADT with surgery. Luteinizing hormone-releasing hormone agonist (LHRHa; leuprolide acetate) does not reduce serum androgens as effectively as abiraterone acetate (AA), a prodrug of abiraterone, a CYP17 inhibitor that lowers serum testosterone (< 1 ng/dL) and improves survival in metastatic PCa. The possibility that greater androgen suppression in patients with localized high-risk PCa will result in improved clinical outcomes makes paramount the reassessment of neoadjuvant ADT with more robust androgen suppression. PATIENTS AND METHODS A neoadjuvant randomized phase II trial of LHRHa with AA was conducted in patients with localized high-risk PCa (N = 58). For the first 12 weeks, patients were randomly assigned to LHRHa versus LHRHa plus AA. After a research prostate biopsy, all patients received 12 additional weeks of LHRHa plus AA followed by prostatectomy. RESULTS The levels of intraprostatic androgens from 12-week prostate biopsies, including the primary end point (dihydrotestosterone/testosterone), were significantly lower (dehydroepiandrosterone, Δ(4)-androstene-3,17-dione, dihydrotestosterone, all P < .001; testosterone, P < .05) with LHRHa plus AA compared with LHRHa alone. Prostatectomy pathologic staging demonstrated a low incidence of complete responses and minimal residual disease, with residual T3- or lymph node-positive disease in the majority. CONCLUSION LHRHa plus AA treatment suppresses tissue androgens more effectively than LHRHa alone. Intensive intratumoral androgen suppression with LHRHa plus AA before prostatectomy for localized high-risk PCa may reduce tumor burden.
منابع مشابه
Re: Intense Androgen-Deprivation Therapy with Abiraterone Acetate plus Leuprolide Acetate in Patients with Localized High-Risk
متن کامل
LATITUDE: A Phase III, Double-Blind, Randomized Trial of Androgen Deprivation Therapy with Abiraterone Acetate Plus Predni- sone or Placebos in Newly Diagnosed High-Risk Metastatic Hormone-Naive Prostate Cancer
Dr. Fizazi and colleagues presented their much anticipated results from the LATITUDE trial at the 2017 American Society of Clinical Oncology (ASCO) annual meeting. LATITUDE is a phase III, double-blind, randomized study that tested androgen deprivation therapy (ADT) with abiraterone acetate (AA) plus prednisone (P) vs. ADT + placebo in men newly diagnosed with highrisk metastatic hormone-naïve ...
متن کاملRe: Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer.
BACKGROUND Abiraterone acetate, a drug that blocks endogenous androgen synthesis, plus prednisone is indicated for metastatic castration-resistant prostate cancer. We evaluated the clinical benefit of abiraterone acetate plus prednisone with androgen-deprivation therapy in patients with newly diagnosed, metastatic, castration-sensitive prostate cancer. METHODS In this double-blind, placebo-co...
متن کاملNeoadjuvant chemotherapy in high-risk localized prostate cancer: a systematic review
Background: The rate of recurrence and mortality in high-risk prostate cancer remains high. On the other hand, the use of chemotherapy in metastatic prostate cancer has improved overall survival of patients. The aim of this study was to evaluate the effect of neoadjuvant chemotherapy alone on increasing survival of patients with high risk localized prostate cancer Methods: This is a systematic...
متن کاملCan targeting the androgen receptor in localized prostate cancer provide insights into why men with metastatic castration-resistant prostate cancer die?
The improved survival observed with abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) who experience disease progression despite conventional androgen-deprivation therapy (ADT) validates the androgen receptor (AR) as a viable target in this group of patients. Yet many questions remain, particularly in light of the so-called bookends of ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- The Journal of urology
دوره 193 6 شماره
صفحات -
تاریخ انتشار 2014