Multicenter study confirms low testosterone in 84 percent of lung cancer patients taking crizotinib

A previous study by the University of Colorado Cancer Center reported the common side effect of low testosterone in men treated with the recently approved lung cancer agent, crizotinib. A new study published this week in the journal Cancer confirms this finding in a multi-national sample, details the mechanism of reduced testosterone, and provides promising preliminary evidence that widely available hormone replacement therapies can alleviate this side effect in many patients.

"This was a wonderful collaboration between multiple centers confirming a side effect that had not been noted when the drug was initially approved by the FDA," says Ross Camidge, MD, PhD, investigator at the CU Cancer Center, director of the thoracic oncology clinical program at University of Colorado Hospital, and the paper's senior author.

Specifically, the study – which included researchers in the United States, Hong Kong, Italy and the UK – found that in 84 percent of men treated with crizotinib, were below the lower limit of normal. Importantly, this study also showed, for the first time, that approximately 80 percent of these men had symptoms associated with their low such as or depression.

Testosterone levels seemed to fall for two main reasons. First, the proteins and SHBG that bind testosterone in the blood and act as a storage depot for the hormone dropped rapidly with crizotinib use. Additionally, free testosterone – the functional form of the hormone that is liberated from these proteins – was also reduced, implying that in addition to challenging the body's ability to store testosterone, crizotinib also challenges the body's ability to produce it. Camidge and colleagues went on to show that when low levels are found, testosterone replacement therapy may alleviate these symptoms.

"With advances in targeted therapies and in the we can use to select who to best give these new treatments to, we're starting to see drugs being approved more quickly and based on the results from far smaller numbers of patients than ever before. That's great: it helps streamline the path of these drugs into clinics where they can benefit patients who desperately need them. However, it also puts the onus on clinicians who then start using these drugs in day-to-day practice to recognize either subtle or later onset side effects that may have been missed during the initial testing," Camidge says.

For example, he says, it's perhaps not surprising that the potential for lowered testosterone was overlooked during the lightning-fast approval process for crizotinib: "If you don't specifically ask a man about symptoms of low testosterone, unless you know the patient very well, he may not feel comfortable bringing these issues up himself," Camidge says.

Now with the possibility of low testosterone in mind, clinicians who prescribe crizotinib to their male patients will know to ask about these symptoms and to test their testosterone levels. "With each breakthrough we're really trying to put people with advanced cancer back in control of their own lives," says Camidge. "The more we can make these highly effective new treatments tolerable, the closer we are to achieving that goal."

Related Stories

Sipuleucel-T in prostate cancer: Added benefit is not proven

date Jan 08, 2015

Sipuleucel-T (trade name Provenge) has been approved since September 2014 for men with metastatic prostate cancer who have few or no symptoms and do not yet require chemotherapy. The German Institute for Quality and Efficiency ...

Recommended for you

Study finds new potential melanoma drug target

date May 02, 2015

A new treatment for melanoma could be on the horizon, thanks to a finding by a UNC Lineberger Comprehensive Cancer Center-led team. In the study, which was published online today in the journal Clinical Ca ...

Surgery for terminal cancer patients still common

date May 02, 2015

The number of surgeries performed on terminally ill cancer patients has not dropped in recent years, despite more attention to the importance of less invasive care for these patients to relieve symptoms and ...

Study provides comprehensive look at brain cancer treatments

date May 01, 2015

Led by the Translational Genomics Research Institute (TGen) and UC San Francisco (UCSF), a comprehensive genetic review of treatment strategies for glioblastoma brain tumors was published today in the Oxford University Press ...

How artificial tanning can lead to melanoma

date May 01, 2015

Young women may be up on the latest fashions and trends as they prepare for prom season. But what many don't know is that the tan that looks oh-so-good with their dress may be the first step toward skin cancer.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.