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Sequencing Questions Remain in Prostate Cancer Paradigm

Danielle Bucco
Published: Tuesday, Feb 13, 2018

Christopher J. Sweeney, MBBS
Christopher J. Sweeney, MBBS
The FDA recently expanded the approval of abiraterone acetate (Zytiga) to include the treatment of patients with metastatic high-risk castration-sensitive prostate cancer, based on findings from the phase III LATITUDE trial.

, Christopher Sweeney, MBBS, a medical oncologist at Dana-Farber Cancer Institute, discussed the role of abiraterone for patients with hormone-sensitive prostate cancer, and what physicians should consider when choosing between abiraterone and docetaxel.

OncLive: How do you determine whether to administer docetaxel or abiraterone to patients with prostate cancer?

Sweeney: Determining between abiraterone and docetaxel is a challenge, as both drugs work well. Abiraterone is an easier drug for most patients to tolerate because it is a hormonal therapy. Docetaxel also has activity, but it has a higher treatment burden.

Either option is appropriate, but it is important to tailor the decision to the patient’s situation, their financial and physical capabilities, and preference.

How big of a factor is financial burden when you are making treatment decisions?

It is a complicated conversation. I will write the prescription and send it to the pharmacy who will determine if it needs an approval. Then, it will go to the billing department, which will determine a patient’s out-of-pocket expenses depending on their coverage. Some patients have no insurance or have no viability of being able to access it. Most of these patients are on Medicare. Their first bill may be something like ,000, and the cost is much less once they are past that. It is a complicated conversation that often takes a couple of weeks to resolve.

Which drug is given more frequently?

This is the subject of many conversations and debates around the world. The fashionable answer is the drug that has the lower treatment burden, abiraterone, is given more. It is a simple hormonal therapy and most patients would be able to tolerate it better than docetaxel. It is easier to give when you think about it from a short-term toxicity perspective. However, we may need to sit back and ask, “What is the bigger and more profitable long-term plan?”

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