Robert Dreicer, MD, MS, chairman of the Department of Solid Tumor Oncology at the Taussig Cancer Institute at the Cleveland Clinic, discusses the sequencing of MDV3100, an androgen receptor antagonist, and abiraterone acetate, an inhibitor of androgen biosynthesis, for patients with castration-resistant prostate cancer.
The MDV3100 data from the AFFIRM trial showed a significant prolongation in survival and a reduced risk of death. Dreicer expects this information will lead to an initial FDA approval in the post-chemotherapy setting.
Data recently released for abiraterone acetate from the COU-AA-302 study suggest this agent may be effective when given before chemotherapy. If this agent were moved to the pre-chemotherapy space the sequencing order would likely be abiraterone acetate, chemotherapy, followed by MDV3100.
If later data suggest MDV3100 can move prior to chemotherapy there will be a larger discussion on sequencing. Dreicer expects the primary discussion points to be whether MDV31000 and abiraterone acetate should be used in combination or absolute sequence.
Dreicer expects a short initial period where the optimal sequence may not be known, but eventually there will be greater insight into the sequencing of these therapies.