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Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Abiraterone acetate (AA) is a standard treatment for prostate cancer, typically administered at 1,000 mg daily under fasting conditions.
  • A significant food effect necessitates specific administration guidelines for standard AA.
  • Abiraterone acetate low dose (AALD), 250 mg with food, offers similar efficacy at a substantially lower cost, addressing accessibility issues in public healthcare systems.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of abiraterone acetate low dose (AALD) in patients with metastatic castration-resistant prostate cancer (mCRPC).
  • To assess the feasibility and impact of AALD in a public healthcare setting where standard dosing is often unaffordable.

Main Methods:

  • Retrospective review of mCRPC patients treated with AALD between March 2021 and May 2023.
  • Primary endpoint: Prostate-specific antigen (PSA) response rate (RR) defined as ≥50% decrease at 12 weeks.
  • Secondary endpoints: Time to treatment failure (TTF), overall survival (OS), and PSA RR ≥50% at nadir.

Main Results:

  • Ninety-six patients were included; 65.6% received AALD as first-line therapy.
  • A PSA response rate of ≥50% at 12 weeks was achieved by 60.2% of patients.
  • First-line AALD showed significantly higher PSA response rates compared to later lines (68.3% vs. 40% at 12 weeks, P=.015).
  • Median TTF was 7.9 months and median OS was 20.6 months.
  • Achieving a ≥50% PSA response at 12 weeks correlated with improved TTF and OS.

Conclusions:

  • AALD demonstrates meaningful efficacy and survival benefits in mCRPC patients.
  • The study supports the use of AALD as a viable and cost-effective treatment option, especially when standard dosing is financially prohibitive.