ROLE OF PREDNISOLONE IN CHEMOTHERAPY FOR PROSTATE CANCER

Urol Oncol. 2015 Aug 5. pii: S1078-1439(15)00333-6. doi: 10.1016/j.urolonc.2015.06.022. [Epub ahead of print]

Low-dose prednisolone in first-line docetaxel for patients with metastatic castration-resistant prostate cancer: Is there a clinical benefit?

Kongsted P1, Svane IM2, Lindberg H3, Daugaard G4, Sengeløv L3.

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Abstract

BACKGROUND: 

Randomized studies have shown improved survival with the combination of docetaxel (D) and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC). We retrospectively investigated whether coadministration of low-dose glucocorticoids has clinical benefits.

MATERIAL AND METHODS: 

Records from 358 patients with metastatic castration-resistant prostate cancer treated consecutively with either D 75mg/m2 every 3 weeks (n = 124) (Rigshospitalet) or D and prednisolone (P) 10mg daily (n = 234) (Herlev Hospital) given as first-line chemotherapy were reviewed. Of these, 15 patients treated with glucocorticoids at initiation of D at Rigshospitalet were excluded. Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 was used to register any grade of peripheral edema, grade ≥2 sensory neuropathy, and grade ≥3 nonhematological toxicity. Background clinical data, rates of toxicity, hospital admissions, dose reductions, and post-D treatments were analyzed by the Chi-squared test or Mann-Whitney U test. Progression-free survival and overall survival were calculated by the Kaplan-Meier method.

RESULTS: 

Patients treated with D alone had a higher incidence of peripheral edema (32% vs. 15%, P<0 .001="" 0.692="" 10="" 3="" 41="" 43="" a="" adjusting="" alkaline="" alone="" also="" and="" antigen="" baseline="" cooperative="" d="" dehydrogenase="" did="" eastern="" febrile="" for="" frequently="" grade="" group="" hazard="" hemoglobin="" higher="" hospitalized="" in="" incidence="" influence="" lactate="" levels="" log-rank="" mainly="" more="" neutropenia="" nonhematological="" not="" of="" oncology="" or="" overall="" owing="" p="" patients="" performance="" phosphatase="" progression-free="" prostate-specific="" ratio="" span="" status="" style="bottom: -0.25em; font-size: 0.8461em; line-height: 1.6363em; position: relative; top: 0.25em; vertical-align: baseline;" survival="" test="" this="" to="" toxicity="" treated="" vs.="" were="" when="" with="">P

 = 0.98, 95% CI: 0.76-1.26, P = 0.89, Cox proportional hazard regression model).

CONCLUSIONS: 

Coadministration of low-dose P reduced the incidence of peripheral edema, grade 3 nonhematological toxicity, and the risk of being admitted owing to febrile neutropenia during treatment with D. Adjusted survival analysis did not indicate that P affected prognosis.