Strategies for managing ACTH dependent mineralocorticoid excess induced by abiraterone

Area of Science:

• Oncology
• Endocrinology
• Pharmacology

Background:

• Abiraterone acetate is a potent inhibitor of androgen synthesis used in prostate cancer treatment.
• A significant side effect of abiraterone is mineralocorticoid excess, potentially limiting its long-term use.
• Effective management strategies for abiraterone-induced side effects are under active clinical investigation.

Purpose of the Study:

• To review the consequences of mineralocorticoid excess due to abiraterone therapy.
• To evaluate the efficacy of current and emerging treatments for managing these side effects.
• To identify optimal therapeutic approaches for improving abiraterone tolerability.

Main Methods:

• Systematic review of acute and long-term effects of mineralocorticoid excess.
• Analysis of prospective studies utilizing abiraterone to assess the incidence and severity of mineralocorticoid excess syndrome.
• Evaluation of therapeutic interventions aimed at mitigating abiraterone-induced mineralocorticoid excess.

Main Results:

• Mineralocorticoid excess symptoms are prevalent in patients treated with abiraterone alone.
• Glucocorticoids (e.g., prednisone) and mineralocorticoid receptor (MR) antagonists (e.g., eplerenone) show potential in managing this syndrome.
• Prednisone (10mg daily) added to abiraterone did not consistently prevent mineralocorticoid excess in randomized trials.
• Eplerenone alone may not fully control mineralocorticoid excess, necessitating glucocorticoid supplementation.

Conclusions:

• The optimal current management involves low-dose glucocorticoid replacement, potentially combined with MR antagonists and salt restriction.
• Therapeutic doses should be adjusted based on regular monitoring of blood pressure, fluid balance, and potassium levels.
• This approach aims to improve the long-term tolerability of abiraterone in prostate cancer patients.