Use of Prednisone With Abiraterone Acetate in Metastatic Castration-Resistant Prostate Cancer
[摘要] The progression of metastatic castration-resistant prostate cancer (mCRPC) despite androgen deprivation therapy and castrate testosterone levels frequently reflects the continued production of androgens in the adrenal glands and within prostate tumor tissue [
1,
2]. Abiraterone acetate is the prodrug of abiraterone, which blocks androgen biosynthesis via inhibition of steroid 17-hydroxylase/17,20-lyase (cytochrome P450c17 [CYP17A1]) [
3]. Abiraterone acetate in combination with prednisone or prednisolone at a low dose of 5 mg twice daily has been shown to improve survival of mCRPC patients previously treated with docetaxel and those who had not received prior chemotherapy [
4,
5]. The administration of abiraterone acetate with glucocorticoids is necessary to manage adverse events related to mineralocorticoid excess, such as hypokalemia, hypertension, and fluid retention, which can occur as a result of CYP17A1 inhibition [
6�?
8]. This review evaluates the basis for the remedial effects of low-dose prednisone to prevent mineralocorticoid excess-related adverse events anticipated with abiraterone acetate therapy and assesses safety concerns about glucocorticoid therapy based on longitudinal studies conducted in autoimmune and inflammatory diseases and cancer.
