Practical guide to the use of abiraterone in castration resistant prostate cancer.
BACKGROUND
While androgen deprivation therapy remains the primary treatment modality for patients with metastatic prostate cancer, treatment is uniformly marked by progression to castration resistant prostate cancer (CRPC). Abiraterone is the first new drug to enter clinical practice in a series of novel agents designed to potently target adrenal and tumor androgen production.


METHODS
Herein, we review the mechanism of action of abiraterone and the phase III data supporting its approval for patients with metastatic CRPC. We discuss practical treatment considerations, including the incidence and management of side effect and monitoring requirements, and conclude by discussing future directions in the use of abiraterone, including early data supporting an expanded role for abiraterone in castration sensitive disease.


RESULTS
Accumulating data emphasize that "androgen independent" or "hormone refractory" tumors remain sensitive to hormonal activation and suggest that despite suppression of circulating testosterone (T), residual tumor androgens play a prominent role in mediating CRPC progression.


CONCLUSIONS
Accordingly, therapeutic strategies such abiraterone that more effectively target production of intratumoral androgens are necessary.
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Elahe A
EA
Mostaghel
Daniel W
DW
Lin
D000728:Androgens / Q000378:metabolism; D000736:Androstenes; D000737:Androstenols / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000378:metabolism; D013739:Testosterone / Q000378:metabolism; D016896:Treatment Outcome
D000728:Androgens; D000736:Androstenes; D000737:Androstenols; D000970:Antineoplastic Agents; D013739:Testosterone; C089740:abiraterone