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Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment: a meta-analysis of randomized controlled trials

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Abstract

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.

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Authors and Affiliations

  1. Division of Urology, European Institute of Oncology, Milan, Italy

    Matteo Ferro, Ottavio de Cobelli, Gennaro Musi, Mihai Dorin Vartolomei, Alessandro Serino & Francesco Alessandro Mistretta

  2. Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy

    Giuseppe Di Lorenzo, Pietro De Placido & Carlo Buonerba

  3. University of Milan, Milan, Italy

    Ottavio de Cobelli

  4. Department of Public Health, Federico II University of Naples, Naples, Italy

    Dario Bruzzese

  5. Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy

    Piero Pignataro

  6. Department of Urology, University of Bologna, Bologna, Italy

    Marco Borghesi

  7. Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania

    Mihai Dorin Vartolomei

  8. Division of Onco-hematology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Vincenzo Cosimato

  9. Second University of Naples, Naples, Italy

    Vincenzo Ieluzzi

  10. Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy

    Daniela Terracciano

  11. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Rocco Damiano & Francesco Cantiello

  12. University of Naples, Naples, Italy

    Matteo Muto

  13. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy

    Giuseppe Lucarelli

  14. Zooprophylactic Institute of Southern Italy, Portici, Italy

    Carlo Buonerba

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  1. Matteo Ferro
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  14. Francesco Cantiello
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  15. Francesco Alessandro Mistretta
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  16. Matteo Muto
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  17. Giuseppe Lucarelli
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  18. Pietro De Placido
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Contributions

Ferro: Project development; Manuscript editing. Di Lorenzo: Project development; Manuscript editing. de Cobelli: Project development; Manuscript editing. Bruzzese: Data analysis. Pignataro: Data collection. Borghesi: Project development. Musi: Project development. Vartolomei: Project development. Cosimato: Data collection. Serino: Data collection. Ieluzzi: Data collection. Terracciano Project development. Damiano Project development; Manuscript editing. Cantiello Project development; Manuscript editing. Mistretta Project development; Manuscript editing. Muto Project development; Manuscript editing. Lucarelli Project development; Manuscript editing. De Placido Project development; Manuscript editing. Buonerba Project development; Data management; Manuscript writing.

Corresponding author

Correspondence to Matteo Ferro.

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No relevant conflicts by any of the authors are to be disclosed.

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The authors have no potential conflicts of interest to disclose relevant to this work. This work is a systematic review of published data, so it does not directly involve human participants and/or animals, not did it require any informed consent or ethics committee approval.

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Ferro, M., Di Lorenzo, G., de Cobelli, O. et al. Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment: a meta-analysis of randomized controlled trials. World J Urol 37, 1049–1059 (2019). https://doi.org/10.1007/s00345-018-2579-x

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  • DOI: https://doi.org/10.1007/s00345-018-2579-x

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