Utility of Low Dose of Abiraterone for Advanced P Ca

• 14 Mar 2020 06:35:58 PM
• |Onco Urology

Dear All,

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.

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2017.76.4381

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.

https://ascopubs.org/doi/pdfdirect/10.1200/JGO.19.00341

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,

Venu

Comments(2)

• 

  Venugopal P

  16 Mar 2020 04:59:17 PM

  Abiraterone Fine Particle Formulation for mCRPC

  Dear All,

  This is a new substitute being made available to reduce the dose of Abiraterone now in standard use. The results of this study has been published by Jillian Chapas-Reed* et al (2020 Published online March 12^th).

  https://journals.sagepub.com/doi/pdf/10.1177/1179561120910125

  Abiraterone acetate fine particle formulation was designed to provide comparable absorption to OAA at a lower dose of 500mg daily with a combination of methyl prednisolone 4mg twice daily. Effect of this formulation with standard Abiraterone dose of 1000mg/day showed that this formulation was safe and outcomes comparable with the standard dose of Abiraterone. The adverse events after this new formulation were found not much different from the 1000mg dose. Hence with the new formulation, the overall dose of abiraterone can be reduced.

  The gross limitation of this study is the smallness of number of patients enrolled.

  In conclusion the study showed Fine particle formulation of Abiraterone has a favourable benefit risk profile over a year in patients with mCRPC.

  With warm Regards,

  Venu

   

• 

  Ravindra Sabnis

  19 Mar 2020 07:33:20 PM

  Prof Venu Sir has brought out very important point from our perspective Slowly more & more literature is coming up for low dose Abi, We should not be afraid to follow this protocol in our practice.