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Specific prednisone regimen safer than others when used with abiraterone for mCR prostate cancer

Key clinical point: The combination of abiraterone with prednisone, 5 mg, twice daily, appears to have the best safety profile in men with mCRPC.

Major finding: Despite a worse safety profile, the highest median radiographic progression-free survival was 26.6 months in the group given dexamethasone.

Study details: Phase 2 open-label randomized controlled trial among 164 men with mCRPC testing combination of abiraterone 1,000 mg with various predni-sone and dexamethasone regimens.

Disclosures: Dr. Attard disclosed personal fees, research support, and travel support from Janssen during the conduct of the study; as well as personal fees research, and/or travel support from numerous other pharmaceutical companies. The study was funded by Janssen EMEA.

Citation:

Attard G et al. JAMA Oncol. Published online June 27, 2019. doi:10.1001/jamaoncol.2019.1011.

Commentary:

Data from this and similar trials of combination abiraterone and glucocorticoid therapy in prostate cancer should be incorporated into practice in a tailored manner, Umang Swami, MD, and coauthors maintain in an invited commentary (JAMA Oncol. Online June 27, 2019. doi:10.1001/jamaoncol.2019.1008).

“In our view, patients who are expected to be on long-term treatment with abiraterone acetate …. should receive prednisone, 5 mg, once daily to mitigate long-term metabolic toxic effects,” they recommend. However, when using this regimen in the population with metastases, oncologists will need to closely monitor serum potassium levels and blood pressure.

“In other circumstances, the corticosteroid dose will need to be individualized,” Dr. Swami and coauthors advise. “For example, a higher dose can be used for men who are nonadherent with close follow-up and when obtaining laboratory tests and close monitoring for mineralocorticoid excess may be difficult. On the other hand, a lower dose of prednisone is recommended for men who have considerable cardiovascular or metabolic comorbidities but who are otherwise compliant.”

Umang Swami, MD, University of Iowa Hospitals and Clinics, Iowa City,

Sumanta K. Pal, MD, City of Hope Comprehensive Cancer Center, Duarte, California, and Neeraj Agarwal, MD, University of Utah, Salt Lake City.