Bumped
Two studies along the lines of using Dexamethasone along with other drugs showing some good results.
Onkologie. 2012;35(5):279-82. doi: 10.1159/000337403. Epub 2012 Apr 24.
Long-term disease stabilization in a patient with castration-resistant metastatic prostate cancer by the addition of lenalidomide to low-dose dexamethasone and celecoxib.
Marschner N, Zaiss M.
Source
Praxis für Interdisziplinäre Onkologie und Hämatologie, Breisacher Strasse 117, Freiburg i.Br., Germany.
[email protected]Abstract
BACKGROUND:
Treatment of castration-resistant prostate cancer (CRPC) remains a challenge considering that most patients are elderly men with significant comorbidities. Alternative treatment strategies to cytotoxic therapy should be explored. There is evidence that the continuous administration of cyclooxygenase 2 (COX2) inhibitors and the immunomodulatory agents thalidomide or lenalidomide can result in longterm disease stabilization.
CASE REPORT:
A 70-year-old patient with castration-resistant metastatic prostate cancer was treated with a combination of low-dose dexamethasone, celecoxib and subsequently lenalidomide. The patient had longterm disease stabilization for 33 months and a very good performance status despite moderate side effects, i.e. moderate Cushing's syndrome and mild laboratory hematologic toxicity.
CONCLUSION:
The addition of lenalidomide to low-dose dexamethasone and celecoxib resulted in an impressive longterm disease stabilization of CRPC in this patient, allowing him to lead an active life with a good quality of life.
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Dexamethasone plus somatostatin-analog manipulation as bone metastasis microenvironment-targeting therapy for the treatment of castration-resistant prostate cancer: a meta-analysis of uncontrolled studies.
Toulis KA, Goulis DG, Msaouel P, Koutsilieris M.
Source
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Ring Road, 54601 Nea Efkarpia, Thessaloniki, Greece.
Abstract
BACKGROUND:
Antisurvival factor therapy for prostate cancer cells (ASF) in castration-resistant prostate cancer, is a hormonal manipulation consisting of a somatostatin analog, which reduces the growth hormone-dependent, systemic IGF-1 production and of oral dexamethasone, which supresses the urokinase type plasminogen activator -mediated "local" increase of IGF-1 bioavailability in the bone metastases, while the patients continue on a luteinizing hormone-releasing hormone analog therapy. Aim: To revisit relevant evidence and provide a quantitative summary estimate of ASF efficacy.
MATERIALS AND METHODS:
A structured review of relevant literature and a meta-analysis of uncontrolled studies and cohorts within trials was carried out at tertiary academic centers. A computerized literature search was conducted in the electronic database Medline from inception to January 2012. To be eligible for inclusion, a study had to report data on the efficacy of ASF in the treatment of castration-resistant prostate cancer, independently of study design or duration. Data synthesis was performed using restricted maximum-likelihood random effects model.
RESULTS:
Four studies fulfilled the inclusion criteria and were used for the evidence synthesis. The probability of a partial response within six months (defined as at least a 50% decrease from baseline prostate-specific antigen concentrations) was 59.5% (95% confidence interval, 49.3% to 69.3%). No evidence of heterogeneity was noted (I(2) 0%). The response noted did not persist over time (median progression-free survival of seven months and median overall survival of 16 months). The uncontrolled nature of the evidence and the paucity of other outcomes of interest need to be taken into account in the interpretation of the results.
CONCLUSION:
ASF manipulation is a safe alternative to standard therapy and induces partial remission lasting for at least six months. This partial response is consistently accompanied with an improvement in bone pain, performance status and quality of life.