Pre-Chemotherapy Abiraterone Acetate in CRPC

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Urologists are the main point of care for many patients with prostate cancer; however, there are benefits to having access to a medical oncologist, Ganesh S. Palapattu, MD, notes. A multidisciplinary treatment approach results in improved outcomes for patients, although it may not always be feasible, Raoul S. Concepcion, MD, suggests. In general, a team approach to care for men with prostate cancer should include input from a medical oncologist, urologist, and radiation oncologist.

Part of the multidisciplinary approach involves determining the best treatment for a patient who develops castration-resistant prostate cancer (CRPC). Many options exist for patients with untreated metastatic CRPC, including abiraterone acetate, enzalutamide, radiotherapy, and chemotherapy. In the phase III COU-AA-302 trial, abiraterone acetate plus prednisone was compared with prednisone and a placebo in approximately 1088 men with untreated CRPC. Early results from the study demonstrated a marked improvement in radiologic progression-free survival (PFS) with abiraterone acetate plus prednisone. These findings led to an accelerated approval for the drug in December 2012, Neal D. Shore, MD, explains.

At the final 49.2-month analysis of the COU-AA-302 study, the median overall survival (OS) was 34.7 months with abiraterone versus 30.3 months with placebo (HR = 0.81; P = .0033). The median rPFS with abiraterone acetate was 16.5 months compared with 8.3 months for prednisone (HR = 0.53; P < .0001).

Abiraterone acetate was the first oral oncolytic approved as a treatment for patients with metastatic CRPC who had not already received chemotherapy, Shore explains. The 4.3-month OS seen with abiraterone is the longest seen with an antiandrogen in this setting, Shore states.

In September 2014, enzalutamide was also approved as a treatment for men with chemotherapy-naive metastatic CRPC, based on the phase III PREVAIL trial. In this study, the median OS was enzalutamide was 32.4 months versus 30.2 months with placebo (HR = 0.71; P <.0001).