1三軍總醫院 外科部 泌尿外科
Could ketoconazole predict the response of abiraterone in patients with metastatic castration-resistant prostate cancer (crpc) pre-treated with docetaxel
Bo-Han Chen1, Chien-Chang Kao1, Tai-Lung Cha1, Guang-Haun Sun1, Dah-Shyong Yu1, Sun-Yran Chang2, Seng-Tang Wu1
Division of Urology, Departments of Surgery, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan1
Buddhist Tzu Chi General Hospital, Taipei, Taiwan2
Due to similar mechanism of anti-androgen, ketoconazole was excluded from COU-AA 301 trial. The purpose of this report was to evaluate the clinical response of ketoconazole and its impact on predicting PSA response for mCRPC following abiraterone.
Materials and Methods:
The study enrolled patients with metastatic castration-resistant prostate cancer who were initiating treatment with docetaxel. We examined associations between ketoconazole therapeutic response and prostate-specific antigen (PSA) effect (the primary end point), freedom from PSA progression (PSA progression–free survival). ECOG performance status, PSA and VAS score were all assessed at baseline and every month until discontinuation.
A total of 7 abiraterone-treated patients were enrolled in our study. 42% patients had been treated with ketoconazole before abiraterone. Among men receiving ketoconazole, patients had lower PSA response trend (20% vs. 53%, P=0.12) and shorter PSA progression–free survival trend (median, 1.4 months vs. 6.0 months; P<0.03). The association between ketoconzaole and abiraterone therapeutic resistance was observed.
The decision between cabazitaxol and abiraterone is still controversial in mCRPC post-docetaxel patients. The response of ketoconazole might be offer clinician to make choice. PSA decline after abiraterone treatment 3 to 6 months is still major clinical predictor of anti-tumor response.