PURPOSE: The combination of high dose ketoconazole and hydrocortisone (HDK) is active against androgen independent prostate cancer (AIPC). Median response times with HDK tend to be brief but a significant minority of AIPC patients benefit with extended responses. Well characterized response and survival information, especially in the cohort of patients who experience these longer, more durable, responses has not been previously reported. Characterization of this subgroup is of particular interest since men with long-term responses derive the greatest benefit from HDK therapy. MATERIALS AND METHODS: The medical records of 78 patients with AIPC treated with HDK between March 1991 and February 1999 were retrospectively reviewed. Baseline clinical and laboratory factors predictive of prolonged response and survival were identified. RESULTS: The median baseline prostate specific antigen (PSA) before the initiation of HDK was 25.1. The number of patients with zero, 1 to 3, and more than 3 lesions on bone scan were 25, 35 and 18, respectively. Median and mean time to PSA progression was 6.7 and 14.5 months. Median and mean survival time was 38.0 and 42.4 months, respectively. Response time and survival were highly correlated (r = 0.799). A total of 34 (44%) men had a greater than 75% decrease in PSA. The median survival times in men with more vs less than a 75% decrease were 60 vs 24 months, respectively. In a Cox proportional hazard regression, prolonged survival was predicted by percent PSA decrease, extent of disease on bone scan and baseline PSA. CONCLUSIONS: Ketoconazole can induce prolonged responses, occasionally lasting for years. Long responses are more likely to occur in men initiating HDK earlier in the course of disease before the cancer burden becomes excessive.
PURPOSE: The combination of high dose ketoconazole and hydrocortisone (HDK) is active against androgen independent prostate cancer (AIPC). Median response times with HDK tend to be brief but a significant minority of AIPC patients benefit with extended responses. Well characterized response and survival information, especially in the cohort of patients who experience these longer, more durable, responses has not been previously reported. Characterization of this subgroup is of particular interest since men with long-term responses derive the greatest benefit from HDK therapy. MATERIALS AND METHODS: The medical records of 78 patients with AIPC treated with HDK between March 1991 and February 1999 were retrospectively reviewed. Baseline clinical and laboratory factors predictive of prolonged response and survival were identified. RESULTS: The median baseline prostate specific antigen (PSA) before the initiation of HDK was 25.1. The number of patients with zero, 1 to 3, and more than 3 lesions on bone scan were 25, 35 and 18, respectively. Median and mean time to PSA progression was 6.7 and 14.5 months. Median and mean survival time was 38.0 and 42.4 months, respectively. Response time and survival were highly correlated (r = 0.799). A total of 34 (44%) men had a greater than 75% decrease in PSA. The median survival times in men with more vs less than a 75% decrease were 60 vs 24 months, respectively. In a Cox proportional hazard regression, prolonged survival was predicted by percent PSA decrease, extent of disease on bone scan and baseline PSA. CONCLUSIONS:Ketoconazole can induce prolonged responses, occasionally lasting for years. Long responses are more likely to occur in men initiating HDK earlier in the course of disease before the cancer burden becomes excessive.
Authors: James Kim; Jean Y Tang; Ruoyu Gong; Jynho Kim; John J Lee; Karl V Clemons; Curtis R Chong; Kris S Chang; Mark Fereshteh; Dale Gardner; Tannishtha Reya; Jun O Liu; Ervin H Epstein; David A Stevens; Philip A Beachy Journal: Cancer Cell Date: 2010-04-13 Impact factor: 31.743
Authors: Aura D Herrera-Martínez; Richard A Feelders; Wouter W de Herder; Justo P Castaño; María Ángeles Gálvez Moreno; Fadime Dogan; Rosanna van Dungen; Peter van Koetsveld; Leo J Hofland Journal: Horm Cancer Date: 2019-05-18 Impact factor: 3.869
Authors: Avivit Peer; Maya Gottfried; Victoria Sinibaldi; Michael A Carducci; Mario A Eisenberger; Avishay Sella; Raya Leibowitz-Amit; Raanan Berger; Daniel Keizman Journal: Prostate Date: 2013-12-11 Impact factor: 4.104
Authors: Daniel Keizman; Maya Gottfried; Maya Ish-Shalom; Natalie Maimon; Avivit Peer; Avivit Neumann; Eli Rosenbaum; Svetlana Kovel; Roberto Pili; Victoria Sinibaldi; Michael A Carducci; Hans Hammers; Mario A Eisenberger; Avishay Sella Journal: Oncologist Date: 2012-09-12
Authors: Bu Hyeon Yun; Eu Chang Hwang; Dong Hoon Yoo; In Sang Hwang; Sun-Ouck Kim; Seung Il Jung; Taek Won Kang; Dong Deuk Kwon; Kwangsung Park; Soo Bang Ryu Journal: Korean J Urol Date: 2011-11-17