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Master Thesis

Acétate d’abiratérone associé à la dexaméthasone dans le cancer de la prostate résistant à la castration‎ : réponse biologique après switch ou rechallenge

Abstract : Abiraterone acetate (AA) combined with prednisone (P) is a major treatment for metastatic castration-resistant prostate cancer (mCRPC). The combination of AA and dexamethasone (D) has been described as another possible option, immediately (switch) or in rechallenge after a different treatment line. 77 patients with mCRPC were included in this retrospective study conducted in two centers. All patients received AA + P. After disease progression on AA+P, patients were treated either first with another drug and then rechallenge of AA combined with D or with an immediate switch from P to D. The criteria for biological relapse were in accordance with the PCWG3 criteria. The efficacy of AA+D was estimated by the proportion of patients with a PSA decline > 50% from baseline value (PSA50), a PSA decline > 30% from baseline value (PSA30) and progression-free survival (SSP). After a median duration of treatment with AA + D of 533 days, the proportion of patients with PSA50 was 28.6% (90% CI: 20.2-38.2) and the proportion of patients with PSA30 was 36.3 % (90% CI: 27-46). The biological response rate was no different whether the patients were treated in a switch or rechallenge context. Patients with prior response on AA + P were more likely to reach PSA50 on AA + D, but the results were not significant: 34.6 % versus 16%. Median SSP on AA+D was 4.2 months. SSP was similar after either switch or rechallenge. A decrease of SSP, without statistical significance, was observed for the late introduction of D into the treatment regimen. Treatment with AA+D was well tolerated, with no grade 3-4 AEs. Change from P to D associated with AA after disease progression on AA+P may resensitize mCRPC to AA, with a PSA 50 response reached in 28.6% of patients and a median SSP of 4.2 months. It appears to be an interesting option in mCRPC, either by directly switching the corticoid or in AA rechallenge. Prospective studies with a larger number of patients are necessary, in order to identify potential predictive criteria for efficacy.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02958655
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Mathieu Jamelot. Acétate d’abiratérone associé à la dexaméthasone dans le cancer de la prostate résistant à la castration‎ : réponse biologique après switch ou rechallenge. Médecine humaine et pathologie. 2020. ⟨dumas-02958655⟩

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