This morning I spoke about the early use of abiraterone for patients with metastatic hormone sensitive prostate cancer. Traditionally abiraterone was approved by the FDA for metastatic castrate resistant disease and if it was given either pre or post docetaxel there was about a three to five month improvement in the median survival for those patients who received abiraterone. The STAMPEDE trial as well as the LATITUDE trial looked at the earlier use of abiraterone in hormone sensitive patients. Nick James led the STAMPEDE trial where they randomised locally advanced or metastatic patients to two years, if they had no evidence of metastatic disease, two years of abiraterone plus hormone therapy versus standard androgen blockade alone. The LATITUDE trial took metastatic patients with three or more bone lesions and randomised them to receive abiraterone plus hormone blockade versus hormone blockade alone. Both trials demonstrated a strikingly similar improvement in the median survival; the hazard ratio, or the reduction in the risk of death, was 37% approximately for both studies. This is comparable to the previous data presented with docetaxel prednisone or docetaxel combined with androgen blockade compared to androgen blockade alone. So this represents a new standard of care for those patients who are hormone sensitive.

The question, of course, is which agent do you use since the hazard ratios do appear to be similar? Remember that it’s difficult to compare two different randomised trials but the way we’re counselling our patients is we’re recommending abiraterone for those patients who may not want to undergo chemotherapy and, of course, patients who have congestive heart failure or liver function abnormalities may not be properly suited for abiraterone as these are known toxicities. So what you have to do is tailor this for the individual patient.