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Would you consider de-escalating abiraterone in a patient treated with ADT/abiraterone/prednisone for metastatic hormone sensitive prostate cancer who has had an excellent response with undetectable PSA and minimal side effects for over 2 years?
Is there a concern regarding rarer side effect emergence (cardiac, bone, muscle, cognitive) of long term exposure to "maximal" androgen deprivation? Is there any expert or institutional experience with de-escalation to guide this further?
Answer from: Medical Oncologist at Academic Institution
Wonderful question. There really is no data to guide this question. Some people are wondering about de-escalation of therapy from the start vs super escalation (triple therapy) for other patients. This strategy makes biologic sense. Match the therapy to the biology of the cancer. The challenge is th...
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Answer from: Medical Oncologist at Community Practice
In selected cases (like this one), it is most likely safe to stop abi (or ADT for that matter) and observe carefully. No literature but people in the field do this at times...