Prostate Cancer Case Studies - Episode 17

Case Study: Managing Symptomatic mCRPC

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Moderator, Raoul S. Concepcion, MD, discusses a scenario in which a patient with metastatic castration-resistant prostate cancer (mCRPC) has progressed rapidly following treatment with sipuleucel-T and is now symptomatic. At this point, Evan Y. Yu, MD, recommends the administration of abiraterone acetate.

Before abiraterone was approved, docetaxel was indicated based on improvements in overall survival (OS) and a delay in pain. Similarly, in addition to the primary endpoints of OS and radiographic progression free survival, abiraterone showed a statistically significant improvement in time-to-opiate use and has a more favorable toxicity profile than docetaxel, Yu says.

The usage of chemotherapy to treat mCRPC has dropped off dramatically, since the approval of abiraterone and enzalutamide, observes Mark C. Scholz, MD. This decline is attributable to the effectiveness of these new hormonal therapies. Overall, Scholz estimates, in the last 18 to 24 months, his practice has used 50% less chemotherapy than historically. However, as time goes by, there is an increase in docetaxel and cabazitaxel usage, as patients progress on abiraterone and enzalutamide.