Glucocorticoid Regimens in Combination With Abiraterone Acetate (Zytiga)

[cbgjr]

Assessment of the Safety of Glucocorticoid Regimens in Combination With Abiraterone Acetate

JAMA Oncology

TAKE-HOME MESSAGE

The authors of this study randomized 164 patients with metastatic castration-resistant prostate cancer (mCRPC) to four different glucocorticoid regimens in combination with abiraterone acetate 1000 mg daily: prednisone 5 mg daily; prednisone 5 mg twice daily; prednisone 2.5 mg twice daily; or dexamethasone 0.5 mg. The primary endpoint was no mineralocorticoid excess, including hypokalemia (any grade) and hypertension (grade >1), during 6 months of treatment. A total of 37% (5 mg daily), 70% (5 mg twice daily), 60% (2.5 mg twice daily), and 70% (dexamethasone 0.5 mg) of patients had no mineralocorticoid excess, and the level of urinary glucocorticoid metabolites appeared higher in patients with mineralocorticoid excess. In addition, median progression-free survival was 15.3 months, 18.5 months, 12.8 months, and 26.6 months, respectively.

This study enables clinicians to better understand the different glucocorticoid regimens used in clinical practice wAssessment of the Safety of Glucocorticoid Regimens in Combination With Abiraterone Acetate

[monte1111]

I read this the other day. And of course everyone can see that dexamethasone with progression free survival at 26.6 is the clear winner. Must be a reason prednisone is being used? One of those cases where 1 plus 1 doesn't equal 2. If I was taking Zytiga, I would be doing a little Sherlock Holmes on this one.

[FCoffey in reply to monte1111]

I'm pretty sure prednisone is being used because that was what they did in the clinical trials for FDA approval of Zytiga.

[Shooter1 in reply to FCoffey]

I wouldn't care. If dex works better that's what I would insist upon.

[nobaday]

I’m 19 months into Zytiga and switched to dexamethssone a couple of months ago even though PSA non detectable.