Barriers included inadequate resources
The 46.7% who had no significant concerns thought implementation was relatively simple once they overcame drug-related barriers, including devoting time to more follow-ups, having inadequate resources, and not having an appropriate infrastructure for implementation.
“Some providers found there were certain barriers to integrating the drug properly—things like following up with labs and making sure that critical results for labs were seen on a very timely manner,” he said. “It’s not in the abstract, but some of the ancillary data we have is such that every practice from every community that we see is a little different. So, the needs of the provider to make sure they develop a good, safe practice for the administration of abiraterone are a little bit different. There has to be novel thinking and very deliberate attempts to evaluate and investigate what details of our practices need to be changed or modified to accommodate abiraterone patients.”
Still, nine in 10 respondents indicated they would continue to treat metastatic castration-resistant prostate cancer patients with abiraterone post-trial.
“The worst thing that could happen is the urologist doesn’t treat and doesn’t refer,” Dr. Feifer said.
While urologists have been intrinsically involved in the administration of antiandrogen therapy for treatment of most prostate cancer stages, treatment of metastatic castration-resistant prostate cancer patients fell largely within the medical oncologist’s domain until recent years.
“We have a keen awareness of how to manipulate testosterone, and we monitor testosterone all the time,” Dr. Feifer said.
Therapies for castration-resistant prostate cancer, however, were relegated to the medical oncologists because urologists had no oral therapies and no therapy that could be delivered in urologists’ offices that were any good, according to Dr. Feifer.
“They were toxic and not very efficacious. Those patients went to medical oncologists at tertiary care centers for the administration of cytotoxic chemotherapy,” he said.
In the last 5 years or so, abiraterone and enzalutamide (XTANDI), an oral androgen receptor blocker, surfaced in phase III studies as resulting in improved survival in men with metastatic castration-resistant prostate cancer, before and after chemotherapy.
These two molecules target an area of which urologists are familiar, according to Dr. Feifer: the androgen receptor axis.