Persistent androgen synthesis under castration status in adrenal gland, testes and tumor cells is thought to be one of the major causes for development and progression of castration-resistant prostate cancer (CRPC).
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Abiraterone acetate (AA), the prodrug of abiraterone, which is an inhibitor of androgen synthesis enzymes, was evaluated for pharmacokinetics, pharmacodynamics, preliminary efficacy and safety in Japanese patients with CRPC in a phase-1, open-label and dose-escalation study. Chemotherapy-naïve Japanese CRPC patients (N=27) received one of four AA daily doses (250 mg [n=9], 500 mg [n=6], 1000 [1 hr premeal] mg [n=6] and 1000 [2 hr postmeal] mg [n=6]) continuously through 28-days treatment cycles. In first cycle, AA monotherapy was given on days 1-7 for pharmacokinetics, and AA plus prednisone (5 mg twice daily) from days 8-28. Nine of 27 patients continued treatment with AA until data cut-off date (18July2013). Over evaluated dose range, plasma abiraterone concentrations increased with dose, with median tmax 2-3 hours. At each dose level, mean serum corticosterone concentrations increased, whilst testosterone and dehydroepiandrosterone sulfate concentrations rapidly decreased following a single AA dose and were further reduced to near the quantification limit on day 8 regardless of the dose. At least three patients from each dose-group experienced ≥50% PSA reduction, suggesting clinical benefit from AA in Japanese CRPC patients. AA was generally well-tolerated, and thus recommended AA dosage regimen in Japanese CRPC patients is thought to be 1000 mg oral dose under modified fasting conditions (at least 1 hour premeal or 2 hours postmeal).
Matsubara N, Uemura H, Fukui I, Niwakawa M, Yamaguchi A, Iizuka K, Akaza H. Are you the author?
Division of Oncology and Hematology, National Cancer Center Hospital East, Japan.
Reference: Cancer Sci. 2014 Aug 13. Epub ahead of print.