Management and challenges of corticosteroid therapy in men with metastatic castrate-resistant prostate cancer

• Published in: Annals of oncology Vol. 24; no. 1; pp. 31 - 38
• Main Authors: Dorff, T.B., Crawford, E.D.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.01.2013; Oxford University Press
• Subjects: Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Antineoplastic agents; Biological and medical sciences; corticosteroid; Gynecology. Andrology. Obstetrics; Humans; Hyperglycemia - chemically induced; immunotherapy; Male; Male genital diseases; Medical sciences; metastatic castrate-resistant prostate cancer; Muscle, Skeletal - drug effects; Neoplasm Metastasis; Nephrology. Urinary tract diseases; Orchiectomy; Osteoporosis - chemically induced; Pharmacology. Drug treatments; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Sleep Initiation and Maintenance Disorders - chemically induced; systemic therapy; treatment sequencing; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; corticosteroid; systemic therapy; metastatic castrate-resistant prostate cancer; immunotherapy; treatment sequencing; Human; Corticosteroid; Urinary system disease; Prostate disease; Male; Malignant tumor; Management; Metastasis; Resistance; Clinical management; Treatment; Immunotherapy; Adult; Advanced stage; Male genital diseases; Prostate cancer; Sequencing; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mds216

Extensive clinical development in metastatic castrate-resistant prostate cancer (mCRPC) has led to the introduction of three new agents in little more than a year, with more on the horizon. With the exception of autologous cellular immunotherapy, all of the agents approved by the US Food and Drug Administration for the treatment of mCRPC are approved for use in combination with corticosteroids. Corticosteroids play a crucial role in the management of men with mCRPC, but the availability of multiple lines of therapy that include corticosteroids raises potential toxicity considerations. In addition, the immunosuppressive effects of corticosteroids may alter the efficacy of immunotherapies. The recent increase in treatment options with different mechanisms of action raises the importance of understanding how corticosteroids are used and the implications of such use on treatment selection and sequencing. A number of corticosteroids with varied potencies are used in general medical practice at varying doses. The differences in potency, dose, and disease settings in which corticosteroids are used complicate the ability to fully understand the impact that any one corticosteroid can have, such as prednisone in prostate cancer. This article reviews the published literature on corticosteroid use in advanced cancer, focusing on their role in mCRPC.