Abiraterone vs docetaxel for metastatic castrate resistant prostate cancer

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Published: 22 Nov 2016
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Dr Shabbir Alibhai - Princess Margaret Cancer Centre, Toronto, Canada

Dr Alibhai speaks with ecancertv at SIOG 2016 about the experience of men receiving abiraterone or docetaxel for the treatment of metastatic castrate resistant prostate cancer. 

He discusses how the efficacy was similar to prior published studies, and how toxicities were slightly greater.

This service has been kindly supported by an unrestricted grant from Merck/MSD.

Our group was interested in looking at the experience of men getting docetaxel or abiraterone for their treatment of metastatic castrate resistant prostate cancer. This was not in a clinical trial, this was in usual clinical care because we know men who get on clinical trials tend to be highly selected, young and relatively fit, even among the older population. So in clinical practice more frail men, men with more comorbidities and older men get put on some of these drugs because they obviously develop castrate resistant prostate cancer. What we wanted to do is understand whether the efficacy was similar to what the published data suggested and whether the toxicity was similar or different.

What we found was that in usual practice we were able to deliver docetaxel to these men, for example in the clinical context, and that the efficacy seemed to be similar to published studies although the toxicities were slightly greater, particularly around fatigue and an increased risk of infections, although generally still fairly well tolerated. Abiraterone was also given to a significant proportion of fairly elderly men and we found that they tolerated it well. The outcomes seemed to be similar to what the studies suggested and the side effect profile was actually quite favourable in these older men.

Should this become standard practice?

Absolutely, I think that more and more men should be getting these drugs in the setting of metastatic castrate resistant prostate cancer because they’re well tolerated, particularly abiraterone and enzalutamide where we have increasing data that they work and they work well, can delay or prevent the need for chemotherapy and are quite well tolerated, even in fairly old or frail men.