Background

Emerging evidence indicates that patients with metastatic castration-resistant prostate cancer could respond to steroid switch from prednisone (P) to dexamethasone (D) following progression on abiraterone acetate plus prednisone (AA+P).

Objectives

Conducting a systematic review to evaluate the efficacy, safety, and prognostic factors of steroid switch.

Materials and methods

We systematically searched Pubmed, Web of Science, and American Society of Clinical Oncology annual meeting abstracts published up to October 2020. Literature review, study selection, and data extraction were conducted by two reviewers. Risk of bias (RoB) and quality of evidence were assessed. A systematic review and pooled analysis were performed.

Results

Nine studies were eligible for inclusion. All of the included patients were progression on AA+P. Pooled rates of PSA50 and PSA30 on abiraterone acetate plus dexamethasone (AA+D) were 0.24 (95%CI [0.18,0.30]) and 0.42 (95%CI [0.36,0.48]), respectively. Subgroup analysis indicated more favorable PSA50 and PSA30 rates on AA+D when switching from P to D only based on PSA progression. Median time to PSA progression on AA+D ranged from 2.73 to 11.38 months. Definitions of progression free survival were variable. Reported median progression free survival on AA+D ranged from 2.52 to 11.8 months. Median overall survival on AA+D varied from 4.11 to 20.9 months. All patients tolerated well on AA+D, and no grade 3 to 4 adverse events were reported. Baseline characteristics of patients, previous treatment and its response, and genetic alterations might all play roles in the response in the response toward the AA+D regimen.

Conclusions

The present systematic review suggested that steroid switch from P to D might be an effective and safe treatment strategy in a subset of patients with metastatic castration-resistant prostate cancer after PSA progression on AA+P.

中文翻译：

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转移性去势抵抗性前列腺癌患者阿比特龙联合泼尼松进展后的类固醇转换：系统评价

背景

新出现的证据表明，在醋酸阿比特龙联合泼尼松 (AA+P) 的进展后，转移性去势抵抗性前列腺癌患者可能会对从泼尼松 (P) 到地塞米松 (D) 的类固醇转换产生反应。

目标

进行系统评价以评估类固醇转换的疗效、安全性和预后因素。

材料和方法

我们系统地检索了截至 2020 年 10 月发表的 Pubmed、Web of Science 和美国临床肿瘤学会年会摘要。文献回顾、研究选择和数据提取由两名评审员进行。评估了偏倚风险（RoB）和证据质量。进行了系统回顾和汇总分析。

结果

九项研究符合纳入条件。所有纳入的患者在 AA+P 上均出现进展。醋酸阿比特龙加地塞米松 (AA+D) 上的 PSA50 和 PSA30 合并率分别为 0.24 (95%CI [0.18,0.30]) 和 0.42 (95%CI [0.36,0.48])。亚组分析表明，当仅基于 PSA 进展从 P 切换到 D 时，AA+D 的 PSA50 和 PSA30 率更有利。AA+D PSA 进展的中位时间范围为 2.73 至 11.38 个月。无进展生存期的定义是可变的。报告的 AA+D 中位无进展生存期为 2.52 至 11.8 个月。AA+D 的中位总生存期从 4.11 个月到 20.9 个月不等。所有患者对 AA+D 耐受性良好，未报告 3 至 4 级不良事件。患者的基线特征、既往治疗及其反应，

结论

目前的系统评价表明，在 AA+P 后 PSA 进展的转移性去势抵抗性前列腺癌患者亚组中，从 P 到 D 的类固醇转换可能是一种有效且安全的治疗策略。