Role of Micronized Abiraterone in Metastatic HSPC


Shared insight on the role of micronized abiraterone in metastatic HSPC and how it may be utilized in practice.


Alicia Morgans, MD, MPH: Sandy, if you could, mention 1 other thing that is important for us to recognize, that there’s another form of abiraterone that clinicians should be aware of. It’s called Yonsa [abiraterone acetate]. Can share your thoughts on this formulation for clinical use?

Sandy Srinivas, MD: We’ve had abiraterone for a long time. One issue with abiraterone has been that it’s given to patients with an empty stomach, so they need to take it 2 hours before food or 1 hour after. It has to do with poor absorption. The need for other agents that improve bioavailability is what led to the development of the fine-particle abiraterone, and that’s what Yonsa [abiraterone acetate] is. Overall, it was studied in a very small number of patients because the intent wasn’t to look at the efficacy in the NCCN [National Comprehensive Cancer Network] Guidelines. Fine particle is listed almost equivalent to abiraterone, but the dosing is a little different. Based on this small study with about 50 patients, the bioequivalent of the fine particle was 500 mg, which was equivalent to that of standard dosing of abiraterone. We’ve had other trials that look at maybe 250 mg of abiraterone taken with food. There are different ways we can use this drug. Essentially, this drug was studied in combination with prednisolone rather than our standard prednisone that we use with abiraterone.

Alicia Morgans, MD, MPH: Thank you. It’s always nice to have options for our patients. There are a couple of considerations, though, that we should make sure are on our radar as we think about clinical trial options in particular for our patients. Evan, would you mind mentioning caveats of things for us to keep in mind if we’re thinking about clinical trials for patients getting treatment with Yonsa [abiraterone acetate]?

Evan Y. Yu, MD: The dosing for Yonsa [abiraterone acetate] is different, which to me doesn’t make a difference. It’s bioequivalent. The challenge is that there are some clinical trials that won’t accept that as abiraterone. There are trials that mandate that a patient will have received abiraterone in the past before, or they don’t get counted, and they’re not eligible for some of the trial options. I want to remind everybody listening that we can’t move the field forward and develop new advancements to help future patients with prostate cancer without clinical trials. Those who are devising clinical trials need to take that into account and need to recognize that this should be considered equivalent to abiraterone when you’re devising these criteria.

Alicia Morgans, MD, MPH: Absolutely. Having less restrictive criteria and allowing this in is going be important as we move forward. Any opportunity to get our patients onto trial is something we should be striving for, and having a logistical error almost in our inclusion criteria or eligibility criteria is something we have the power to do something about, so thank you for that message.

Transcript edited for clarity.

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