Abiraterone Acetate: A Game-Changing Treatment for Prostate Cancer

Abiraterone is an irreversible inhibitor of CYP17A known as 17,20 lyase and 17-α hydroxylase and is a member of the CYP/CYP450 family, which converts pregnanes into steroid hormones and androgen precursors.  Abiraterone acetate can block androgen production in the testicles, the adrenal gland and prostate tumours, thereby preventing tumour growth. In 2014, abiraterone acetate was approved for the treatment of castration-resistant prostate cancer. In 2020, the American Cancer Society estimated new cases of prostate cancer in the United States to be about 191,930 and 33,330 associated deaths. 

Currently, prostate cancer is the most common cancer amongst American men other than skin cancer.  Over the last decade, the average survival rate for metastatic prostate cancer has improved with the introduction of new therapies.  Until 2015, the treatment of prostate cancer had remained unchanged since Huggins first published his study in 1941 on androgen deprivation therapy.  

The majority of patients will show an initial response to androgen deprivation therapy; some will develop resistance and progress toward castration-resistant prostate cancer after 18-36 months from the initial biochemical response.  There are several therapeutic treatments available for metastatic castration-resistant prostate cancer. 

Abiraterone acetate has triggered a number of evaluation studies in the metastatic hormone-sensitive prostate cancer population.  Two pivotal randomized controlled trials explored the efficacy and safety of abiraterone acetate in metastatic hormone-sensitive prostate cancer patients.  The first is called the LATITUDE study, which uses abiraterone acetate with a low dose of prednisolone. The second study was STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy).

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