Abiraterone in the management ofcastration-resistant prostate cancerprior to chemotherapy

摘要

The treatment armamentarium for metastatic castration-resistant prostate cancer(mCRPC) has increased significantly over the past several years. Approved drugs associatedwith improved survival include androgen pathway-targeted agents (abiraterone acetateand enzalutamide), chemotherapeutics (docetaxel and cabazitaxel), an autologous vaccine(sipuleucel-T) and a radiopharmaceutical (radium-223). Abiraterone acetate, a prodrugof abiraterone, inhibits the CYP17A enzyme, a critical enzyme in androgen biosynthesis.Abiraterone has regulatory approval in mCRPC in both chemotherapy-naive patients and in thepost-docetaxel setting based on results from two randomized phase III studies. In the COU-AA-302 trial, abiraterone demonstrated significant improvement in the coprimary endpointsof radiographic progression-free survival and overall survival, as well as in a number ofsecondary endpoints including time until initiation of chemotherapy, time until opiate usefor cancer-related pain, prostate-specific antigen progression-free survival and decline inperformance status. Abiraterone is well-tolerated, although adverse events associated withthis agent include abnormalities in liver function testing and mineralocorticoid-associatedadverse events. This review evaluates the use of abiraterone in mCRPC prior to the use ofchemotherapy.