New paper below.
"Abiraterone and spironolactone in prostate cancer: a combination to avoid."
Acta Clin Belg. 2018 Nov 26:1-6. doi: 10.1080/17843286.2018.1543827. [Epub ahead of print]
Abiraterone and spironolactone in prostate cancer: a combination to avoid.
Dhondt B1,2,3, Buelens S1,3, Van Besien J1, Beysens M1, De Bleser E1,2,4, Ost P2,4, Lumen N1,3.
a Department of Urology , Ghent University Hospital , Ghent , Belgium.
b Department of Radiation Oncology and Experimental Cancer Research , Laboratory of Experimental Cancer Research, Ghent University , Ghent , Belgium.
c Cancer Research Institute Ghent , Ghent , Belgium.
d Department of Radiation Oncology and Experimental Cancer Research , Ghent University Hospital , Ghent , Belgium.
Disease progression in metastatic castration-resistant prostate cancer (mCRPC) is dependent on androgen signaling. This case describes the complex adaptive androgen signaling mechanisms in mCRPC and illustrates that caution should be exercised when treating these patients with drugs influencing the androgen axis.
Single case report and review of the literature.
We report the case of an 86-year-old man with mCRPC, treated with the secondary antihormonal agent abiraterone acetate. Following association of spironolactone to deal with symptoms related to mineralocorticoid excess, biochemical and radiographic disease progression occurred. Spironolactone was discontinued and 8 months after withdrawal, the patient continues to show a biochemical response to abiraterone.
Although spironolactone generally exerts anti-androgenic effects, experimental evidence exists that it acts as an androgen receptor agonist in an androgen-depleted environment, capable of inducing prostate cancer proliferation. This is supported by the observations described in this case report. Therefore, spironolactone should be avoided in prostate cancer patients suffering from treatment-associated side effects of abiraterone.
Abiraterone; CYP17; androgen receptor; mineralocorticoid excess; prostate cancer; spironolactone
PMID: 30477405 DOI: 10.1080/17843286.2018.1543827