Helpt u ons aan 500 donateurs om kanker-actueel online te houden?

En als donateur kunt u ook korting krijgen bij verschillende bedrijven, waaronder bij Medpro voor o.a. prostasol  een veelgebruikt natuurlijk middel bij prostaatkanker als alternatief voor hormoontherapie

https://kanker-actueel.nl/NL/voordelen-van-ops-lidmaatschap-op-een-rijtje-gezet-inclusief-hoe-het-kookboek-en-de-recepten-op-basis-van-uitgangspunten-van-houtsmullerdieet-te-downloaden-enof-in-te-zien.html

Of u kunt een urinetest laten doen bij oplopende PSA, zie deze informatie:  

https://kanker-actueel.nl/mdxhealth-ontwikkelde-een-urinetest-biomarkertest-select-mdx-die-aantoont-of-een-verhoogde-psa-gerelateerd-is-aan-prostaatkanker-en-meet-ook-de-agressiviteit-als-het-prostaatkanker-blijkt-te-zijn.html

5 april 2018: Bron: HOPA 2018

Mannen met castratie-resistente prostaatkanker bereiken zelfde resultaten op PSA waarden en progressievrije ziekte als zij alleen abiraterone gebruiken zonder hormoontherapie in vergelijking met combinatiebehandeling van abiraterone met hormoontherapie. Dit blijkt uit een kleinschalige studie gepresenteerd op HOPA 2018

De onderzoekers volgden binnen een zogeheten retrospectieve cohortstudie in 1 ziekenhuis (Het Universitair Medisch Centrum van Minnesota) 57 mannen met castratieresistente, uitgezaaide prostaatkanker die behandeld werden tussen 1 januari 2012 en 1 augustus 2017. Van deze patiënten waren er 10 patiënten (17%) behandeld met alleen abiraterone en 36 patiënten (64%) werden behandeld met abirateron + hormoontherpaie (androgeen deprivatie therapie) en 11 patiënten (19%) werden behandeld met abiraterone + androgeen deprivatie therapie, gevolgd door alleen abiraterone.

In de 84 metingen onder de mannen die alleen abiraterone kregen, bleek de mediane serumtestosteronspiegel 1,9 ng / dL, vergeleken met 0,5 ng / dL voor de 115 metingen bij mannen die de combinatietherapie hadden gekregen (P = 0,14). Voor mannen die begonnen waren met de combinatietherapie en daarna zijn overgegaan op alleen abiraterone, namen de mediane serumtestosteronspiegels toe van 0,61 tot 4,83 ng / dL (P = 0,07). Al deze waarden lagen ver onder het maximum en doel van 50 ng / dL. In feite was de serumtestosteron bij slechts één patiënt alleen maar groter dan deze drempelwaarde en hij had bevestigd dat hij zijn behandeling niet trouw had nageleefd.

"Er was geen verschil in de serumtestosteronconcentraties tussen patiënten behandeld met abiraterone in vergelijking met abiraterone + androgeendeprivatie therapie", zegt studieleider Dr. Engle. "We vergeleken ook de progressievrije overleving en vonden geen verschil tussen de 2 groepen. Als alle patiënten in de studie alleen met abiraterone zouden worden behandeld, schatten we een kostenvermijding van meer dan $ 1,25 miljoen op basis van de gemiddelde groothandelsprijs van leuprolide."

Het volledige studierapport is nog niet vrij gegeven zover ik kan zien. Maar zie ook studieprotocol van de SPARE studie: Trial of Abiraterone Acetate Plus LHRH-therapy Versus Abiraterone Acetate Sparing LHRH-therapy in Patients With Progressive Chemotherapy-naïve Castration-resistant Prostate Cancer (SPARE) (SPARE)

Interessant is ook deze studie: Prospective International Randomized Phase II Study of Low-Dose Abiraterone With Food Versus Standard Dose Abiraterone In Castration-Resistant Prostate Cancer waarin een lagere dosis abiraterone ingenomen emt minder voeding wordt vergeleken met een hogere dosis met meer voeding in te nemen:

Uit het volledige studierapport: (referentielijst staat onderaan dit artikel)

Importantly, both PSA response and time to progression in both arms within this study were comparable to previous studies.3,11,24 In further support of the central hypothesis, serum androgen levels decreased to a similar extent within both arms in the study. Although the sensitivity of the testosterone assay used was not sufficient to measure testosterone changes at the lowest measured levels, DHEA-S, which has been used in measuring abiraterone efficacy,17,23 was able to be measured with high sensitivity (because of the relative abundance of this androgen in circulation) and fell to the same extent in both arms of the study. Thus, the two pharmacodynamic end points examined, changes in PSA and androgen levels, point to similarity between LOW and STD dosing of AA for patients with CRPC.

Hier de originele gegevens uit de poster van HOPA 2018:

The investigators conducted a single-center, retrospective cohort study of 57 men with castration-resistant metastatic prostate cancer treated at the University of Minnesota Medical Center between January 1, 2012 and August 1, 2017. Of these patients, 10 (17%) were treated with abiraterone alone, 36 (64%) were treated with abiraterone + androgen deprivation therapy, and 11 (19%) were treated with abiraterone + androgen deprivation therapy, followed by abiraterone alone. 

In the 84 measurements taken among the men who received abiraterone alone, median serum testosterone level was 1.9 ng/dL, compared with 0.5 ng/dL for the 115 measurements taken in men on combination therapy (P = .14). For men who started on combination therapy and then transitioned to abiraterone alone, median serum testosterone levels increased from 0.61 to 4.83 ng/dL (P = .07). All of these values were well below the target of 50 ng/dL. In fact, serum testosterone only increased beyond this threshold in 1 patient, and he had documented non-adherence to chemotherapy. 

“There was no difference in the serum testosterone concentrations between patients treated with abiraterone vs those treated with abiraterone + androgen deprivation therapy,” said Dr. Engle. “We also compared progression-free survival and found no difference between the 2 groups. If all patients in the study were treated with abiraterone alone, we estimated a cost avoidance of over $1.25 million based on average wholesale price of leuprolide.” 

Still, this is a small, retrospective, single-center study that requires confirmation, said Dr. Engle. In addition, he noted, it is unclear whether androgen deprivation therapy has antitumor activity beyond testosterone suppression. An ongoing randomized, prospective trial known as SPARE, which is comparing clinical outcomes between treatment with abiraterone and combination abiraterone + androgen deprivation therapy, will help answer this question.

References: Prospective International Randomized Phase II Study of Low-Dose Abiraterone With Food Versus Standard Dose Abiraterone In Castration-Resistant Prostate Cancer

REFERENCES
1. Ryan CJ, Molina A, Li J, et al: Serum androgens as prognostic biomarkers in castration-resistant prostate cancer: Results from an analysis of a randomized phase III trial. J Clin Oncol 31:2791-2798, 2013 Link
2. de Bono JS, Logothetis CJ, Molina A, et al: Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 364:1995-2005, 2011 Crossref, Medline
3. Ryan CJ, Smith MR, de Bono JS, et al: Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 368:138-148, 2013 Crossref, Medline
4. Fizazi K, Tran N, Fein L, et al: Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 377:352-360, 2017 Crossref, Medline
5. James ND, de Bono JS, Spears MR, et al: Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med 377:338-351, 2017 Crossref, Medline
6. Malangone-Monaco E, Foley K, Varker H, et al: Prescribing patterns of oral antineoplastic therapies observed in the treatment of patients with advanced prostate cancer between 2012 and 2014: Results of an oncology EMR analysis. Clin Ther 38:1817-1824, 2016 Crossref, Medline
7. Caram MEV, Borza T, Min HS, et al: Early national dissemination of abiraterone and enzalutamide for advanced prostate cancer in Medicare Part D. J Oncol Pract 13:e694-e702, 2017 Link
8. Janssen Biotech I: Zytiga. https://www.zytiga.com
9. Pilon D, Queener M, Lefebvre P, et al: Cost per median overall survival month associated with abiraterone acetate and enzalutamide for treatment of patients with metastatic castration-resistant prostate cancer. J Med Econ 19:777-784, 2016 Crossref, Medline
10. Astellas Pharma: Information for Vermont prescribers of prescription drugs (long form): Xtandi (enzalutamide) capsules. https://astellasuswebitms.blob.core.windows.net/vermont/Xtandi Long Form.pdf
11. Ryan CJ, Smith MR, Fong L, et al: Phase I clinical trial of the CYP17 inhibitor abiraterone acetate demonstrating clinical activity in patients with castration-resistant prostate cancer who received prior ketoconazole therapy. J Clin Oncol 28:1481-1488, 2010 Link
12. Stuyckens K, Saad F, Xu XS, et al: Population pharmacokinetic analysis of abiraterone in chemotherapy-naïve and docetaxel-treated patients with metastatic castration-resistant prostate cancer. Clin Pharmacokinet 53:1149-1160, 2014 Crossref, Medline
13. Janssen Biotech: Highlights of prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/202379s021lbl.pdf
14. Center for Drug Evaluation and Research: Application number: 202379Orig1s000. Clinical pharmacology and biopharmaceutics review(s). https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/202379orig1s000clinpharmr.pdf
15. Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 45:228-247, 2009 Crossref, Medline
16. Scher HI, Halabi S, Tannock I, et al: Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: Recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 26:1148-1159, 2008 Link
17. Kim W, Zhang L, Wilton JH, et al: Sequential use of the androgen synthesis inhibitors ketoconazole and abiraterone acetate in castration-resistant prostate cancer and the predictive value of circulating androgens. Clin Cancer Res 20:6269-6276, 2014 Crossref, Medline
18. Xu XS, Ryan CJ, Stuyckens K, et al: Correlation between prostate-specific antigen kinetics and overall survival in abiraterone acetate-treated castration-resistant prostate cancer patients. Clin Cancer Res 21:3170-3177, 2015 Crossref, Medline
19. Danila DC, Morris MJ, de Bono JS, et al: Phase II multicenter study of abiraterone acetate plus prednisone therapy in patients with docetaxel-treated castration-resistant prostate cancer. J Clin Oncol 28:1496-1501, 2010 Link
20. Karrison TG, Maitland ML, Stadler WM, et al: Design of phase II cancer trials using a continuous endpoint of change in tumor size: Application to a study of sorafenib and erlotinib in non small-cell lung cancer. J Natl Cancer Inst 99:1455-1461, 2007 Crossref, Medline
21. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. Journal Am Stat Assn 53:457-481, 1958 Crossref
22. Carton E, Noe G, Huillard O, et al: Relation between plasma trough concentration of abiraterone and prostate-specific antigen response in metastatic castration-resistant prostate cancer patients. Eur J Cancer 72:54-61, 2017 Crossref, Medline
23. Ryan CJ, Peng W, Kheoh T, et al: Androgen dynamics and serum PSA in patients treated with abiraterone acetate. Prostate Cancer Prostatic Dis 17:192-198, 2014 Crossref, Medline
24. Ryan CJ, Shah S, Efstathiou E, et al: Phase II study of abiraterone acetate in chemotherapy-naive metastatic castration-resistant prostate cancer displaying bone flare discordant with serologic response. Clin Cancer Res 17:4854-4861, 2011 Crossref, Medline
25. Chi KN, Spratlin J, Kollmannsberger C, et al: Food effects on abiraterone pharmacokinetics in healthy subjects and patients with metastatic castration-resistant prostate cancer. J Clin Pharmacol 55:1406-1414, 2015 Crossref, Medline
26. Jain RK, Brar SS, Lesko LJ: Food and oral antineoplastics: More than meets the eye. Clin Cancer Res 16:4305-4307, 2010 Crossref, Medline
27. Kang SP, Ratain MJ: Inconsistent labeling of food effect for oral agents across therapeutic areas: Differences between oncology and non-oncology products. Clin Cancer Res 16:4446-4451, 2010 Crossref, Medline
28. Devriese LA, Koch KM, Mergui-Roelvink M, et al: Effects of low-fat and high-fat meals on steady-state pharmacokinetics of lapatinib in patients with advanced solid tumours. Invest New Drugs 32:481-488, 2014 Crossref, Medline
29. Ratain MJ: Targeted therapies: Redefining the primary objective of phase I oncology trials. Nat Rev Clin Oncol 11:503-504, 2014 [Erratum Nat Rev Clin Oncol 12:126, 2015]
30. Morris MJ, Molina A, Small EJ, et al: Radiographic progression-free survival as a response biomarker in metastatic castration-resistant prostate cancer: COU-AA-302 results. J Clin Oncol 33:1356-1363, 2015 Link
31. Hussain M, Goldman B, Tangen C, et al: Prostate-specific antigen progression predicts overall survival in patients with metastatic prostate cancer: Data from Southwest Oncology Group Trials 9346 (Intergroup Study 0162) and 9916. J Clin Oncol 27:2450-2456, 2009 Link
32. O’Donnell A, Judson I, Dowsett M, et al: Hormonal impact of the 17alpha-hydroxylase/C(17,20)-lyase inhibitor abiraterone acetate (CB7630) in patients with prostate cancer. Br J Cancer 90:2317-2325, 2004 Crossref, Medline
33. Szmulewitz RZ, Ratain MJ: Playing Russian roulette with tyrosine kinase inhibitors. Clin Pharmacol Ther 93:242-244, 2013 Crossref, Medline

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