TY - JOUR
T1 - Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment
T2 - a meta-analysis of randomized controlled trials
AU - Ferro, Matteo
AU - Di Lorenzo, Giuseppe
AU - de Cobelli, Ottavio
AU - Bruzzese, Dario
AU - Pignataro, Piero
AU - Borghesi, Marco
AU - Musi, Gennaro
AU - Vartolomei, Mihai Dorin
AU - Cosimato, Vincenzo
AU - Serino, Alessandro
AU - Ieluzzi, Vincenzo
AU - Terracciano, Daniela
AU - Damiano, Rocco
AU - Cantiello, Francesco
AU - Mistretta, Francesco Alessandro
AU - Muto, Matteo
AU - Lucarelli, Giuseppe
AU - De Placido, Pietro
AU - Buonerba, Carlo
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Cancer-related fatigue (CRF) is a complex condition that is reported in > 50% of cancer patients. In men with castration-resistant prostate cancer (CRPC), CRF was reported in 12–21% of patients. Approved systemic therapy against CRPC is commonly administered in combination with androgen-deprivation treatment (ADT) and, in some cases, with daily, low-dose corticosteroids. Importantly, the use of low-dose corticosteroids is associated with multiple negative effects, including reduced muscle mass. On these grounds, we hypothesized that the chronic use of corticosteroids may increase the incidence of fatigue in patients with prostate cancer. Methods: We reviewed all randomized trials published during the last 15 years conducted in patients with prostate cancer receiving systemic treatment and we performed a sub-group analysis to gather insights regarding the potential differences in the incidence of fatigue in patients receiving vs. not receiving daily corticosteroids as part of their systemic anti-neoplastic regimen. Results: Overall, 22,734 men enrolled in prospective randomized phase II and III trials were evaluable for fatigue. Estimated pooled incidence of grade 1–2 fatigue was 30.89% (95% CI = 25.34–36.74), while estimated pooled incidence of grade 3–4 fatigue was reported in 3.90% (95% CI = 2.91–5.02). Sub-group analysis showed that grade 3–4 fatigue was approximately double in patients who received daily corticosteroids as part of their anti-neoplastic treatment (5.58; 95% CI = 4.33–6.98) vs. those who did not (2.67%; 95% CI = 1.53–4.11). Conclusion: Our findings highlight the need for ad hoc-designed prospective clinical trials to investigate whether the benefits associated with low-dose, daily corticosteroids outweigh the risks associated with corticosteroid-related adverse events such as fatigue.
AB - Background: Cancer-related fatigue (CRF) is a complex condition that is reported in > 50% of cancer patients. In men with castration-resistant prostate cancer (CRPC), CRF was reported in 12–21% of patients. Approved systemic therapy against CRPC is commonly administered in combination with androgen-deprivation treatment (ADT) and, in some cases, with daily, low-dose corticosteroids. Importantly, the use of low-dose corticosteroids is associated with multiple negative effects, including reduced muscle mass. On these grounds, we hypothesized that the chronic use of corticosteroids may increase the incidence of fatigue in patients with prostate cancer. Methods: We reviewed all randomized trials published during the last 15 years conducted in patients with prostate cancer receiving systemic treatment and we performed a sub-group analysis to gather insights regarding the potential differences in the incidence of fatigue in patients receiving vs. not receiving daily corticosteroids as part of their systemic anti-neoplastic regimen. Results: Overall, 22,734 men enrolled in prospective randomized phase II and III trials were evaluable for fatigue. Estimated pooled incidence of grade 1–2 fatigue was 30.89% (95% CI = 25.34–36.74), while estimated pooled incidence of grade 3–4 fatigue was reported in 3.90% (95% CI = 2.91–5.02). Sub-group analysis showed that grade 3–4 fatigue was approximately double in patients who received daily corticosteroids as part of their anti-neoplastic treatment (5.58; 95% CI = 4.33–6.98) vs. those who did not (2.67%; 95% CI = 1.53–4.11). Conclusion: Our findings highlight the need for ad hoc-designed prospective clinical trials to investigate whether the benefits associated with low-dose, daily corticosteroids outweigh the risks associated with corticosteroid-related adverse events such as fatigue.
KW - Corticosteroids
KW - Fatigue
KW - Meta-analysis
KW - Prostate cancer
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U2 - 10.1007/s00345-018-2579-x
DO - 10.1007/s00345-018-2579-x
M3 - Review article
C2 - 30519742
AN - SCOPUS:85057743647
VL - 37
SP - 1049
EP - 1059
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 6
ER -