Combination of statin/vitamin D and metastatic castration-resistant prostate cancer (CRPC): a post hoc analysis of two r
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BRIEF RESEARCH ARTICLE
Combination of statin/vitamin D and metastatic castration‑resistant prostate cancer (CRPC): a post hoc analysis of two randomized clinical trials A. Carretero‑González1 · D. Lora2 · R. Manneh3 · D. Lorente4 · D. Castellano1 · G. de Velasco1 Received: 25 February 2020 / Accepted: 1 March 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract In castration-resistant prostate cancer (CRPC) patients, observational studies have reported that statins may boost the antitumor activity of abiraterone (AA) and data suggest an improvement in efficacy; conclusions with vitamin D are less clear but an eventual benefit has been pointed. We conducted a post hoc analysis of individual patient data of CRPC patients treated with prednisone and/or AA with or without statins/vitamin D on randomized clinical trials. In the COU-AA-301 trial, use of AA with statin and vitamin D reduced the risk of death by 38% (p = 0.0007) while AA alone was associated with a decrease of 10% (p = 0.025), compared to prednisone alone. Meanwhile, in the COU-AA-302 trial, use of AA plus statin plus vitamin D was associated with a reduced risk of death of 26% (p = 0.0054). In this data analysis from two prospective randomized clinical trials, statin and vitamin D use was associated with superior overall survival in metastatic CRPC patients treated with AA and prednisone. To our knowledge, this is the first report suggesting the impact of statin plus vitamin D in this population. New strategies using big data may help to clarify these questions easily and in a most cost-effective approach. Keywords Castration-resistant prostate cancer · Abiraterone · Statins · Vitamin D · Survival
Background Awareness of the impact of treatment beyond pharmacological cancer therapy is growing, concretely co-medication. Observational studies have suggested the potential of co-medication as enhancer of efficacy in cancer patients. Statins and vitamin D have shown positive data in prevention of several cancer types, especially prostate cancer [1]. Moreover, numerous studies have shown that long-term use of statins might help to reduce cancer-related mortality [2]. Lower serum vitamin D levels have shown to increase the * G. de Velasco [email protected] 1
Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
2
Clinical Research Unit, IMAS12‑CIBERESP, University Hospital 12 de Octubre, Madrid, Spain
3
Oncology and Hematology Society From Cesar, Valledupar, Colombia
4
Medical Oncology Department, Hospital Provincial de Castellón, Castellón de la Plana, Spain
risk of prostate cancer [3]. Different old drugs are being used for new applications but which ones are the trusted comedications for cancer patients are unknown. In castration-resistant prostate cancer (CRPC) patients, retrospective studies have reported that statins may boost the antitumor activity of abiraterone (AA) and data suggest an improvement in survival [4]. By lowering cholesterol levels (substrate for all steroid hormon
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