Dr. Agarwal on Remaining Challenges With Abiraterone in mCSPC

Neeraj Agarwal, MD, a professor of medicine and director of the Genitourinary Oncology Program at the Huntsman Cancer Institute, discusses remaining challenges with abiraterone acetate (Zytiga) in metastatic castration-sensitive prostate cancer (mCSPC). 

In February 2018, the antiandrogen abiraterone, in combination with prednisone, was approved for the treatment of patients with high-risk mCSPC based on findings from the phase 3 LATITUDE trial. Results from the study showed that the combination reduced the risk of death by 38% within this patient population. 

Despite the benefit abiraterone can yield for patients, challenges remain regarding its utility, explains Agarwal. Although a low dose of prednisone is given concomitantly with abiraterone, low-dose prednisone is associated with worsening diabetes, hypertension, and cardiovascular health. Moreover, the effects of long-term prednisone use are not fully understood with regard to cardiovascular risk, glucose intolerance, diabetes, osteoporosis, or osteopenia, Agarwal adds. 

Additionally, abiraterone requires patients to visit treatment centers for mandatory lab work every 15 days within the first 2 to 3 months of treatment initiation, Agarwal says. Given the ongoing coronavirus disease 2019 pandemic, patients receiving abiraterone are often reluctant to come into the clinic, concludes Agarwal.