Pre-chemo Tx: More ammo for urologists

October 16, 2014

The time is right for urologists to become familiar with all aspects of the use and delivery of these drugs.

The recent report of the final analysis of COU-AA-302 at the 2014 European Society of Medical Oncology Congress adds another weapon in the armamentarium in the fight against metastatic, castration-resistant prostate cancer.

Ryan et al reported overall survival and safety outcomes in 1,088 patients randomized to abiraterone acetate (ZYTIGA), 1,000 mg, plus oral prednisone, 5 mg twice daily, versus prednisone plus placebo with a medium follow-up of 49.4 months. Patients in the placebo arm were allowed to cross over to the treatment arm, and 44% ultimately received abiraterone after unblinding. Abiraterone plus prednisone significantly prolonged overall survival versus prednisone alone (34.7 vs. 30.3 months).

RELATED: Second mCRPC agent significant benefit pre-chemo

Adverse events were infrequent, with grade 3/4 hypertension in 4.6% of patients, hypokalemia (2.6%), increase in ALT (5.9%), and increase in AST (3.3%).

This is the second drug in recent months to show significant improvement in overall survival in chemotherapy-naïve patients. Data from PREVAIL, the phase III trial of enzalutamide (XTANDI), showed that agent significantly reduced the risk of radiographic progression or death by 83% versus placebo.

Chemo-naive patients routinely start out in the urologist’s office, but many practices elicit the aid of their medical oncology colleagues following failure of androgen deprivation therapy. We now have a second drug with a very favorable safety profile, ease of delivery, and a familiar mechanism of action for the urologist. The time is right for urologists to become familiar with all aspects of the use and delivery of these drugs.

Further, the current data lead the way for many more interesting studies in the patient with metastatic prostate cancer. It certainly appears that earlier delivery of abiraterone is beneficial, but how early? What will be the best sequencing of these new agents? Will combination therapy prove superior to single-drug therapy? These are exciting times for those who treat advanced prostate cancer, but with so many new weapons, the time is now for urologist’s to engage in their use and continue to research the best sequence of delivery.

The recent report of the final analysis of COU-AA-302 at the 2014 European Society of Medical Oncology Congress adds another weapon in the armamentarium in the fight against metastatic, castration-resistant prostate cancer.

Ryan et al reported overall survival and safety outcomes in 1,088 patients randomized to abiraterone acetate (ZYTIGA), 1,000 mg, plus oral prednisone, 5 mg twice daily, versus prednisone plus placebo with a medium follow-up of 49.4 months. Patients in the placebo arm were allowed to cross over to the treatment arm, and 44% ultimately received abiraterone after unblinding. Abiraterone plus prednisone significantly prolonged overall survival versus prednisone alone (34.7 vs. 30.3 months).

Adverse events were infrequent, with grade 3/4 hypertension in 4.6% of patients, hypokalemia (2.6%), increase in ALT (5.9%), and increase in AST (3.3%).

This is the second drug in recent months to show significant improvement in overall survival in chemotherapy-naïve patients. Data from PREVAIL, the phase III trial of enzalutamide (XTANDI), showed that agent significantly reduced the risk of radiographic progression or death by 83% versus placebo.

Chemo-naive patients routinely start out in the urologist’s office, but many practices elicit the aid of their medical oncology colleagues following failure of androgen deprivation therapy. We now have a second drug with a very favorable safety profile, ease of delivery, and a familiar mechanism of action for the urologist. The time is right for urologists to become familiar with all aspects of the use and delivery of these drugs.

Further, the current data lead the way for many more interesting studies in the patient with metastatic prostate cancer. It certainly appears that earlier delivery of abiraterone is beneficial, but how early? What will be the best sequencing of these new agents? Will combination therapy prove superior to single-drug therapy? These are exciting times for those who treat advanced prostate cancer, but with so many new weapons, the time is now for urologist’s to engage in their use and continue to research the best sequence of delivery.

J. Brantley Thrasher, MD

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