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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Armstrong, Andrew J. Shen, Tong Halabi, Susan Kemeny, Gabor Bitting, Rhonda L. Kartcheske, Patricia Embree, Elizabeth Morris, Karla Winters, Carolyn Jaffe, Tracy Fleming, Mark George, Daniel J. |
| Description | Author Affiliation: Armstrong AJ ( Duke Cancer Institute and the Duke Prostate Center, Duke University, Durham NC) |
| Abstract | BACKGROUND: Phosphatase and tensin homologue (PTEN) loss is common in advanced prostate cancer, leading to constitutive activation of the PI3 kinase pathway. Temsirolimus blocks mammalian target of rapamycin (mTOR)/target of rapamycin complex 1 (TORC1), a key signaling node in this pathway; its activity in men with advanced castration-resistant metastatic prostate cancer (mCRPC) is unknown. METHODS: We conducted a single-arm trial of weekly intravenous temsirolimus administration in men with chemorefractory mCRPC who had ≥ 5 circulating tumor cells (CTCs) at baseline. The primary end point was the change in CTCs at 8 weeks; secondary end points were composite progression-free survival (PFS) (excluding prostate-specific antigen [PSA]), PSA and radiographic response rates, safety, and survival. At PSA/CTC progression, an anti-androgen could be added while continuing temsirolimus. RESULTS: Eleven patients were accrued out of a planned 20; the trial was stopped prematurely because of lack of efficacy/feasibility. Median age was 61 years, with 55% African-Americans and 36% Caucasian patients. Median baseline PSA level was 390 ng/dL, median baseline number of CTCs was 14 cells; 50% of patients had pain, and 63% had undergone ≥ 2 previous chemotherapy regimens. Median CTC decline was 48% and 3 patients experienced decline in CTCs to < 5. However, 73% of men had a persistently unfavorable number of CTCs (≥ 5) and only 1 patient had a ≥ 30% PSA decline. Median PFS was 1.9 months (95% confidence interval [CI], 0.9-3.1) and median overall survival (OS) was 8.8 months (95% CI, 3.1-15.6). Toxicities included grade 4 hypophosphatemia and central nervous system (CNS) hemorrhage, and frequent grade 3 fatigue, anemia, stomatitis, hypokalemia, weakness, and hyperglycemia. CONCLUSION: Temsirolimus lacked sufficient clinical activity in men with mCRPC, despite transient CTC improvements in some men. Future studies should focus on combination approaches or novel PI3K pathway inhibitors. |
| File Format | HTM / HTML |
| ISSN | 15587673 |
| Issue Number | 4 |
| Volume Number | 11 |
| e-ISSN | 19380682 |
| Journal | Clinical Genitourinary Cancer |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2013-12-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Urology Discipline Oncology Prostatic Neoplasms, Castration-resistant Drug Therapy Protein Kinase Inhibitors Adverse Effects Therapeutic Use Sirolimus Analogs & Derivatives Adult Aged Bone Neoplasms Secondary Disease Progression Disease-free Survival Humans Male Middle Aged Multiprotein Complexes Antagonists & Inhibitors Neoplastic Cells, Circulating Phosphatidylinositol 3-kinase Prostate-specific Antigen Blood Mortality Survival Tor Serine-threonine Kinases Treatment Failure Clinical Trial, Phase Ii Journal Article Multicenter Study Research Support, Non-u.s. Gov't |
| Content Type | Text |
| Resource Type | Article |
| Subject | Urology Oncology |
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