Rapid androgen cycling as treatment for patients with prostate cancer Journal Article

Authors: Feltquate, D.; Nordquist, L.; Eicher, C.; Morris, M.; Smaletz, O.; Slovin, S.; Curley, T.; Wilton, A.; Fleisher, M.; Heller, G.; Scher, H. I.
Article Title: Rapid androgen cycling as treatment for patients with prostate cancer
Abstract: Purpose: To investigate the safety and feasibility of rapid androgen cycling for men with progressive prostate cancer. Experimental Design: Schedule 1 included a 4-week induction of androgen depletion, followed by 4-week treatment cycles of a monthly gonadotropin-releasing hormone agonist, testosterone on days 1 to 7, and an estrogen patch on days 8 to 21. Schedule 2 included a 12-week induction of androgen depletion followed by 4-week cycles of gonadotropin-releasing hormone agonist and testosterone, but no estrogens for patients with a prostate-specific antigen (PSA) nadir <1 ng/mL after induction. The primary end point was serially declining PSA trough values over six treatment cycles. Results: Thirty-six patients were treated; 27 were evaluable after cycling, of whom 8 of 12 (67%) and 9 of 15 (60%) on schedules 1 and 2, respectively, reached the end point, five patients with PSA >1 ng/mL following induction did not cycle. No patient progressed radiographically or clinically during cycling. Three posttherapy PSA patterns were observed: a decline followed by a rapid increase in trough levels, a sustained decline with a plateau at a detectable nadir, and a decline to an undetectable nadir. Mean testosterone levels were castrate at the time of trough and in the normal physiologic range following androgen repletion. Major toxicities included grades 1 and 2 fatigue, hepatitis, gynecomastia, and hot flashes. Conclusions: Rapid hormonal cycling is feasible and well tolerated, and successive declines in PSA troughs are achievable. Although the sample size was small, the proportion of patients achieving declining PSA at the end of six cycles was comparable with that reached with continuous androgen depletion therapy. © 2006 American Association for Cancer Research.
Keywords: adult; clinical article; controlled study; aged; middle aged; androgen; fatigue; hepatitis; drug safety; cancer radiotherapy; prostate specific antigen; drug administration schedule; estrogen; estrogens; gonadorelin; carcinogenesis; prostate cancer; prostate-specific antigen; prostatic neoplasms; goserelin; leuprorelin; feasibility studies; prostatectomy; carcinoma; neoplasm metastasis; androgen receptor; diethylstilbestrol; bicalutamide; ketoconazole; antineoplastic agents, hormonal; drug half life; estradiol; gynecomastia; gonadotropin-releasing hormone; testosterone; androgens
Journal Title: Clinical Cancer Research
Volume: 12
Issue: 24
ISSN: 1078-0432
Publisher: American Association for Cancer Research  
Date Published: 2006-12-15
Start Page: 7414
End Page: 7421
Language: English
DOI: 10.1158/1078-0432.ccr-06-1496
PUBMED: 17189414
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 8" - "Export Date: 4 June 2012" - "CODEN: CCREF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Andrew Wilton
    27 Wilton
  2. Glenn Heller
    351 Heller
  3. Susan Slovin
    212 Slovin
  4. Michael Morris
    347 Morris
  5. Martin Fleisher
    278 Fleisher
  6. Howard Scher
    975 Scher
  7. Caitlin Eicher
    7 Eicher