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The role of ketoconazole in current prostate cancer care

Vaibhav Patel1, Bobby Liaw2, William Oh3

  • 1Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. vaibhav.patel@mountsinai.org.

Nature Reviews. Urology
|August 30, 2018
PubMed

Insights

Ketoconazole, a CYP17A1 inhibitor, shows clinical efficacy for castration-resistant prostate cancer (CRPC) without improving survival. Its low cost and favorable toxicity profile support its use in specific CRPC patient groups.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Ketoconazole is a nonselective steroid 17α-hydroxylase/17,20 lyase (CYP17A1) inhibitor.
  • It has been used off-label as a second-line therapy for castration-resistant prostate cancer (CRPC).

Purpose of the Study:

  • To re-evaluate the role of ketoconazole in the current CRPC treatment landscape.
  • To determine optimal timing and sequencing of ketoconazole with other agents to maintain quality of life.

Main Methods:

  • Review of clinical efficacy and toxicity data for ketoconazole in CRPC.
  • Comparison of ketoconazole with newer CRPC therapies like abiraterone acetate, enzalutamide, and apalutamide.

Main Results:

  • Ketoconazole demonstrates clinical efficacy in CRPC but without a survival benefit.
  • It offers a low cost and a favorable toxicity profile compared to chemotherapy.
  • Efficacy is noted both before and after chemotherapy treatment.

Conclusions:

  • Ketoconazole can be considered for nonmetastatic CRPC patients.
  • It is a viable option for metastatic CRPC patients unresponsive to, intolerant of, or lacking access to standard therapies.

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