Switch from abiraterone plus prednisone to abiraterone plus dexamethasone at asymptomatic PSA progression in patients with metastatic castration-resistant prostate cancer.

OBJECTIVE: To evaluate the effects of switching from prednisone (P) to dexamethasone (D) at asymptomatic prostate-specific antigen (PSA) progression in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA). MATERIALS AND METHODS: Among 93 patients treated with AA between January 2013 and April 2016 in our institution, 48 consecutive asymptomatic patients with mCRPC, who experienced biochemical progression on treatment with AA+P 10 mg/day, were included. A corticosteroid switch to AA+D 0.5 mg/day at PSA increase was administered until radiological and/or clinical progression. The primary endpoint was progression-free-survival (PFS). A prognostic score based on independent prognostic factors was defined. RESULTS: The median time to PSA progression on AA+P was 8.94 months. The median PFS on AA+D and AA+corticosteroids (P then D) was 10.35 and 20.07 months, respectively. A total of 56.25% of patients showed a decrease or stabilization in PSA levels after the switch. In univariate analysis, three markers of switch efficiency were significantly associated with a longer PFS: long hormone-sensitivity duration (≥5 years; median PFS 16.62 vs 4.17 months, hazard ratio [HR] 0.30, 90% confidence interval [CI] 0.16-0.56); low PSA level at the time of switch (<50 ng/mL; median PFS 15.21 vs 3.86 months, HR 0.33, 90% CI 0.18-0.60); and short time to PSA progression on AA+P (<6 months; median PFS 28.02 vs 6.65 months, HR 0.41 (90% CI 0.21-0.81). In multivariate analysis, hormone sensitivity duration and PSA level were independent prognostic factors. CONCLUSION: A steroid switch from P to D appears to be a safe and non-expensive way of obtaining long-term responses to AA in selected patients with mCRPC. A longer PFS has been observed in patients with previous long hormone sensitivity duration, and/or low PSA level and/or short time to PSA progression on AA+P.

Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission.

OBJECTIVES: The goal of this study was to evaluate the long-term outcome after consolidation intraperitoneal (IP) chemotherapy in patients with a negative second-look laparotomy (SLL) following first-line intravenous chemotherapy for advanced ovarian cancer. METHODS: This study included patients with FIGO stage III-IV ovarian cancer who entered into four prospective trials (1984-1995) including intravenous chemotherapy based on cisplatin (six cycles) and anthracycline, early debulking surgery after three cycles of chemotherapy in the case of initial residual disease >2 cm, SLL, and IP consolidation chemotherapy. Among 218 patients, 68 with biopsy-negative SLL received every 4 weeks three consolidation cycles of IP chemotherapy (mitoxantrone, cisplatin, etoposide) via a totally implantable port. Long-term outcome of these patients is reported. RESULTS: Mean age was 56 years (33-72 years). Overall, 51% of the patients had at least a grade 3 or 4 toxic effect. Main toxic effects were leukopenia, abdominal pain related to the catheter, and nausea and vomiting. Only 13 patients (19%) did not receive the full three cycles. The median progression-free survival (PFS) for the whole population is 34 months, 34% of the patients being estimated to be free of disease at 5 years. The median overall survival is 73 months, and the 5-year survival is 58%. CONCLUSIONS: In this selected population treated with IP consolidation chemotherapy, prolonged survival was observed. However, the occurrence of late relapses in this most favorable patient category underlines the need to improve the consolidation therapy options in ovarian cancer.