When everything else stops working this old med might prolong life a bit. Case study of Megestrol (MA)

[Graham49]

“Finally, after disease progression during enzalutamide, we decided to start a new line of hormone therapy. In fact, considering age, PS, and patient’s will, available therapeutic options were running out, but particularly we trusted a disease’s residual sensitivity to androgen receptor-targeted therapies. MA, blocking androgen receptor and adrenal hormonal synthesis, managed to overcome resistance to ARTAs, getting a dramatic biochemical and radiological response and a rapid improvement of symptoms.”

Megestrol Acetate for Heavily Pretreated Metastatic Castration-Resistant Prostate Cancer: An Old Answer for a New Problem

Maria La Vecchia; Daniele Galanti; Ivan Fazio; Rosario Paratore; Nicolò Borsellino

Case Rep Oncol (2022) 15 (1): 312–317.

doi.org/10.1159/000522086

[Islandboy2021]

I have read the report. My question is would this MA work if a patient didn't respond well with Abiraterone. I was never able to try Enzalutamide following SOC.

[Graham49 in reply to Islandboy2021]

I don’t know.

See 2000 clinical trial report for 149 men. Although this does not answer your specific question, it does indicate that it works better with some patients than other patients.

RESULTS

“The median survival times of 11.2 months for patients who received the low dose and 12.1 months for patients who received the high dose therapy were not significantly different. Best response was equivalent in the 2 arms: 2 partial responses and 22 patients with stable disease for the 160 mg/day dose, and 1 partial response and 28 patients with stable disease for the 640 mg/day dose. A greater than 50% decline in PSA occurred in 13.8% and 8.8% of patients in the low and high dose treatment arms, respectively. There were no differences in the toxicity or quality-of-life outcomes between the two arms. Poorer performance status (2 vs. 0–1), greater than 5% weight loss, higher baseline PSA, and measurable disease all predicted shorter survival.”

A randomized study comparing standard versus moderately high dose megestrol acetate for patients with advanced prostate carcinoma

Cancer and Leukemia Group B study 9181 † ‡

Nancy A. Dawson M.D., Mark Conaway Ph.D., Susan Halabi Ph.D., Eric P. Winer M.D., Eric J. Small M.D., Diana Lake M.D., Nicholas J. Vogelzang M.D.

First published: 20 November 2000

doi.org/10.1002/(SICI)1097-...