Opinion
Video
Abiraterone Acetate: Generic and Branded Options
Author(s):
Paul E. Dato, MD, discusses how when selecting abiraterone for metastatic hormone-sensitive prostate cancer patients, there are 3 formulations to consider: standard, generic, and micronized versions, with considerations for bioavailability, fasting requirements, and patient adherence.
Clinical Brief: Abiraterone Formulation Selection for Metastatic Hormone-Sensitive Prostate Cancer
Main Discussion Topics
- Available Formulations: Standard abiraterone, generic abiraterone, and micronutrient (micronized) formulation
- Selection Factors: Cost, familiarity, availability, tolerability, and patient access/insurance coverage
- Bioavailability Considerations: Standard and generic formulations require strict fasting (NPO for 2 hours before and 1 hour after), while micronized version can be taken with food
- Special Populations: Challenges for diabetic patients and those with gastroesophageal reflux disease when managing fasting requirements
Key Points for Physicians
- All formulations have equal bioavailability when taken as prescribed
- Micronized formulation enhances bioavailability, allowing lower dosage (500 mg vs 1000 mg)
- Food consumption with standard/generic formulations can lead to elevated drug plasma levels and toxicity
- Lower dosage of micronized version may reduce common adverse effects such as fatigue
Notable Insights
The presenter personally prefers the micronized formulation due to its nonfasting requirement and potentially better tolerance and regimen adherence but notes that cost and access remain significant barriers.
Clinical Significance
Selection of abiraterone formulation should be individualized based on patient factors including comorbidities, risk of nonadherence to fasting requirements, and insurance coverage to optimize therapeutic outcomes while minimizing adverse effects.
