Dr. Scher on Corticosteroids and Enzalutamide in mCRPC

Howard I. Scher, MD, Chief of the Genitourinary Oncology Service at the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan-Kettering Cancer Center, discusses the impact of corticosteroids on outcomes for men with metastatic castration-resistant prostate cancer (mCRPC) receiving treatment with enzalutamide.

The administration of corticosteroids is common and appropriate in the management of symptoms for patients with prostate cancer, Scher notes. However, the impact of progression on corticosteroid efficacy has not been examined. To address this issue, a retrospective, initially unplanned, analysis of the AFFIRM trial was designed to explore the on-study impact of corticosteroid administration on outcomes.

In the phase III AFFIRM trial, 1199 men with mCRPC who had progressed on treatment with docetaxel were randomized 2:1 to receive enzalutamide or placebo. Results from the trial showed a significant improvement in median overall survival, which led to the FDA approval of the agent.

In general, patients receiving corticosteroids had more advanced disease and were generally sicker, Scher explains. To compensate for this, a multivariate analysis was performed to correct for several factors associated with worse outcomes. Following this analysis, the study found that corticosteroid administration remained a factor that correlated with worse outcomes. However, despite this, enzalutamide still provided benefit for these patients in the trial.

Scher notes that the key to this information is context. The administration of a corticosteroid by itself does not seem to have any negative effects. However, patients who are progressing on steroids seem to demonstrate a negative effect. Preliminary, Scher explains, there is evidence suggesting that in some settings corticosteroids may actually contribute to tumor growth.

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