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

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