Phase 1 trial of high-dose exogenous testosterone in patients with castration-resistant metastatic prostate cancer.
BACKGROUND
Growth of selected castration-resistant prostate cancer (CRPC) cell lines and animal models can be repressed by reexposure to androgens. Low doses of androgens, however, can stimulate tumor growth.


OBJECTIVE
We performed a phase 1 clinical trial to determine the safety of high-dose exogenous testosterone in patients with castration-resistant metastatic prostate cancer (CRMPC).


METHODS
Patients with progressive CRMPC who had been castrate for at least 1 yr received three times the standard replacement dose of transdermal testosterone.


METHODS
Cohorts of 3-6 patients received testosterone for 1 wk, 1 mo, or until disease progression.


METHODS
Toxicities, androgen levels, prostate-specific antigen (PSA) assays, computed tomography (CT) scans, bone scintigraphy, positron emission tomography (PET) scans, and metastatic tumor biopsy androgen receptor levels were assessed.


CONCLUSIONS
Twelve patients were treated-three in cohorts 1 and 2 and six in cohort 3. No pain flares were noted. One patient came off study because of epidural disease, which was treated with radiation. Average testosterone levels were within normal limits, although dihydrotestosterone (DHT) levels on average were supraphysiologic in cohort 3. One patient achieved a PSA decline of >50% from baseline. No objective responses were seen. For cohort 3, median time on treatment was 84 d (range: 23-247 d).


CONCLUSIONS
We have demonstrated that patients with CRMPC can be safely treated in clinical trials using high-dose exogenous testosterone. Patients did not, on average, achieve sustained supraphysiologic serum testosterone levels. Future studies should employ strategies to maximize testosterone serum levels, use contemporary methods of identifying patients with androgen receptor overexpression, and utilize PSA Working Group II Consensus Criteria clinical trial end points.


BACKGROUND
ClinicalTrials.gov; NCT00006044.
Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. morrism@mskcc.org
Michael J
MJ
Morris
Daisy
D
Huang
William K
WK
Kelly
Susan F
SF
Slovin
Ryan D
RD
Stephenson
Caitlin
C
Eicher
Anthony
A
Delacruz
Tracy
T
Curley
Lawrence H
LH
Schwartz
Howard I
HI
Scher
D000368:Aged; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013739:Testosterone / Q000008:administration & dosage*; D017211:Treatment Failure
D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone