Utility of Low Dose of Abiraterone for Advanced P Ca
Though in India, the incidence of P Ca is still low when compared to many affluent countries, the incidence appears to be increasing with better diagnostics now available. Though the number of radical prostatectomies have increased considerably during the past some years, even today most of the cases that we come across are Hormone sensitive Advanced P Ca.
Hormonal therapy (Leuprolide) is the most frequent treatment offered to these patients. Some consider Degarelix better but one will have to take the cost factor into consideration.
Since 2011, Abiraterone is being considered as a drug for patients with mCRPC. It is usually given in a dose of 1000 mg along with 5mg Prednisone daily on empty stomach. This drug being costly in Indian scenario, many refrain from prescribing this drug even though it has shown its usefulness.
In 2018, Russell Z Szmulewitz* et al showed that this drug can be given at a lower dose of 250mg /day take with a light breakfast and they found that this alternate regime was non inferior to the standard recommended dose and schedule.
This alternative regime has been mentioned in NCCN Guideline on P Ca in its 2019 v4.
Taking a cue from this Amol Patel, Ian F Tannock and other Indian Oncologists (2020) has published a study in JCO Global Oncology where in many Indian Oncologists have already commenced this low dose regime of Abiraterone. In Indian market, Abiraterone 250 mg cost Rs16000 a bottle of 120 tablets. They estimated that mean per patient savings was US$3,640, with annual savings of US$182 million in India.
As mentioned that this low dose Abiraterone Regime is non inferior to standard regime means more patients in India can be prescribed with this drug. The standard dose now recommended is not well tolerated by many patients and could be this low dose regime will be better tolerated.
With warm Regards,