Abiraterone Acetate in Metastatic Castration-resistant Prostate Cancer

The Unanticipated Real-World Clinical Experience

Darren M. C. Poon; Kuen Chan; S. H. Lee; T. W. Chan; Henry Sze; Eric K. C. Lee; Daisy Lam; Michelle F. T. Chan

Disclosures

BMC Urol. 2016;16(12) 

In This Article

Background

Androgen deprivation therapy (ADT), either medical or surgical, is the backbone of first line treatment for metastatic prostate cancer.[1] While up to 80 % of patients will respond favorably to this therapy; metastatic castration-resistant disease (mCRPC), would be encountered ultimately.[2]

Since 2004, docetaxel chemotherapy was the standard of care for patients with mCRPC.[3,4] More recently, the treatment paradigm had been altered dramatically with the advent of several androgen receptor (AR) pathway targeted agents, new-generation chemotherapy, and immunotherapy.[5] Abiraterone acetate (AA), a potent and irreversible inhibitor of cytochrome-P (CYP)-17 that blocks androgen synthesis, has been shown in large-scale randomized trials to confer significant survival advantage over placebo in both chemo-naïve mCRPC patients and mCRPC patients with prior chemotherapy (post-chemo).[6,7]

There is much interest in confirming whether the efficacy of AA demonstrated within the trial setting is reproducible in routine clinical practice, in consideration of possible differences in selection of patients, ethnic differences, and other factors in day-to-day practice. In fact, for the case of docetaxel for mCRPC patients, previous retrospective studies had shown unexpectedly higher incidence of febrile neutropenia and less favorable survival outcome compared to that in the trial setting.[8,9] In the present study, we report on the clinical outcome of AA in patients with mCRPC from all 6 public oncology centers in Hong Kong.

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