Effective Management of Prostate Cancer - Episode 6
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Raoul D. Concepcion, MD, and Daniel Saltzstein, MD, discuss treatment for post-docetaxel prostate cancer patients.
Concepcion begins the conversation by asking his colleagues what treatments are currently approved for these patients.
Daniel Saltzstein, MD, highlights cabazitaxel (Jevtana), which was approved in 2011 for docetaxel failure, for prostate cancer. He says that it showed some modest survival benefit (2.4 to 2.8 months) but also higher incidence of neutropenic sepsis and grade 3 to 4 toxicities.
Saltzstein comments that urologists are often uncomfortable administering cabazitaxel. In his practice, he works closely with a medical oncologist and passes his patients along to receive cabazitaxel when they fail first-line chemotherapy.
Concepcion says that while cabazitaxel was the first “out of the shoot” for patients that failed docetaxel, oral agents are being introduced now. Oral agents allow for urologists to continue being involved in patient care in the advanced stage.
Abiraterone (Zytiga), an androgen biosynthesis inhibitor, saw a greater than four-month survival advantage in a study with prednisone, Saltzstein says. Abiraterone blocks CYP17 like ketoconazole, but does so in a more specific way. Prednisone, Saltzstein says, should be given with abiraterone to mitigate excess mineral corticoid problems.