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Abiraterone acetate for metastatic castration-resistant prostate cancer post-docetaxel

Hein Van Poppel, Susanne Osanto,Steven Joniau

Abiraterone acetate (AA) 1000-mg daily, a selective irreversible androgen biosynthesis inhibitor of cytochrome P450 c17 (CYP17) enzyme, is used in combination with prednisone 10-mg daily to treat docetaxel-treated patients with metastatic castration-resistant prostate cancer (mCRPC). Several studies have demonstrated the safety and efficacy of this compound in men with mCRPC. Interim results from a randomized Phase III study in CRPC patients previously treated with docetaxel demonstrated an improvement in overall survival (OS) for the AA–prednisone group versus the placebo–prednisone group (14.8 vs 10.9 months; hazard ratio [HR] = 0.646, p < 0.001). An updated survival analysis showed an improvement in median OS in the treatment group (15.8 vs 11.2 months, HR = 0.740, p < 0.0001). The objective is to critically analyse the emerging role of AA as novel, orally administered androgen synthesis inhibitor and its place for treatment of mCRPC patients following failure of docetaxel chemotherapy. This manuscript reviews the pharmacology, clinical evidence data and use of AA in post-docetaxel patients with mCRPC