Abiraterone Acetate in Patients with Advanced Castrate Resistant Prostate Cancer: Initial Real Life Experience in 2 Cancer Units


  • Jamal Zekri Al-Faisal University, Oncology Department, King Faisal Specialist Hospital and Research Centre, P.O. Box 40049, Jeddah 21499, Jeddah, Saudi Arabia
  • Ayman Ramadan Colchester General Hospital, Colchester, Essex, CO4 5JL, England, UK
  • Muthu Kumar Colchester General Hospital, Colchester, Essex, CO4 5JL, England, UK
  • Rasha Haggag Oncology Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia; Department of Oncology, Zagazig University, Eygpt




Abiraterone Acetate, Castrate resistant, Prostate cancer, Hormonal therapy.


Introduction: Abiraterone Acetate (AA) improves outcome of patients with castrate resistant prostate cancer (CRPC) and is currently recommended for chemo-naïve patients and after progression on chemotherapy. We reviewed our initial experience with the use of AA in these patients. Patients and Methods: Forty six consecutive CRPC patients were treated with AA 1000 mg/day and prednisolone 5 mg twice daily in 2 cancer centres in England and Saudi Arabia. Treatment was continued until disease progression or unacceptable toxicity. Patients achieving prostate specific antigen decline (PSA) 50% were considered as marker responders. Results: Median age was 76 (52-91) years. 28 and 18 patients received AA in pre-chemotherapy and post-chemotherapy setting respectively. PSA marker response was achieved in 56.1% (23/41) assessable patients. Objective radiological response rate was seen in 31.6% (6/19) and stable disease in 15.8% (3/19) assessable patients. After a median follow up of 20 months, median time to PSA progression was 12 months (95% CI: 9.5-14.5) and median overall survival was not reached (mean = 21 months, 95% CI: 18-24.5). Toxicity was assessed in 18 patients. All grades adverse events of special interest were hypokalaemia (22%) and hypertension (11%). Conclusion: In daily clinical practice, AA is an effective treatment for patients with CRPC. It produces meaningful marker and objective responses, marker progression free survival and OS that are comparable to those reported in clinical trials. Monitoring of blood pressure and serum potassium is recommended.


Seidenfeld J, Samson DJ, Hasselblad V, Aronson N, Albertsen PC, Bennett CL, et al. Single-therapy androgen suppression in men with advanced prostate cancer: a systematic review and meta-analysis. Ann Intern Med 2000; 132(7): 566-77. http://dx.doi.org/10.7326/0003-4819-132-7-200004040-00009

Montgomery RB, Mostaghel EA, Vessella R, Hess DL, Kalhorn TF, Higano CS, et al. Maintenance of intratumoral androgens in metastatic prostate cancer: a mechanism for castration-resistant tumor growth. Cancer Res 2008; 68(11): 4447–54. http://dx.doi.org/10.1158/0008-5472.CAN-08-0249

Kumagai J, Hofland J, Erkens-Schulze S, Dits NFJ, Steenbergen J, Jenster G, et al. Intratumoral conversion of adrenal androgen precursors drives androgen receptor-activated cell growth in prostate cancer more potently than de novo steroidogenesis. Prostate 2013; 73(15): 1636-50. http://dx.doi.org/10.1002/pros.22655

Small EJ, Halabi S, Dawson NA, Stadler WM, Rini BI, Picus J, et al. Antiandrogen withdrawal alone or in combination with ketoconazole in androgen-independent prostate cancer patients: a phase III trial (CALGB 9583). J Clin Oncol 2004; 22(6): 1025-33. http://dx.doi.org/10.1200/JCO.2004.06.037

Yun BH, Hwang EC, Yoo DH, Hwang IS, Kim S-O, Jung S Il, et al. Comparison of ketoconazole and estramustine for treating patients with castration-resistant prostate cancer. Korean J Urol 2011; 52(11): 746-51. http://dx.doi.org/10.4111/kju.2011.52.11.746

Fizazi K, Scher HI, Molina A, Logothetis CJ, Chi KN, Jones RJ, et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2012; 13(10): 983-92. http://dx.doi.org/10.1016/S1470-2045(12)70379-0

Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, et al. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 2013; 368(2): 138-48. http://dx.doi.org/10.1056/NEJMoa1209096

Ryan CJ, Smith MR, Fizazi K, Saad F, Mulders PFA, Sternberg CN, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2015; 16(2): 152-60. http://dx.doi.org/10.1016/S1470-2045(14)71205-7

Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004; 351(15): 1502-12. http://dx.doi.org/10.1056/NEJMoa040720

Beer TM, Armstrong AJ, Rathkopf DE, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med 2014; 371(5): 424-33. http://dx.doi.org/10.1056/NEJMoa1405095

Scher HI, Fizazi K, Saad F, Taplin M-E, Sternberg CN, Miller K, et al. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med 2012; 367(13): 1187-97. http://dx.doi.org/10.1056/NEJMoa1207506

Sweeney CJ, Chen Y-H, Carducci M, Liu G, Jarrard DF, Eisenberger M, et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med 2015; 373(8): 737-46. http://dx.doi.org/10.1056/NEJMoa1503747

James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet (London, England) 2015.

van Soest RJ, van Royen ME, de Morrée ES, Moll JM, Teubel W, Wiemer EAC, et al. Cross-resistance between taxanes and new hormonal agents abiraterone and enzalutamide may affect drug sequence choices in metastatic castration-resistant prostate cancer. Eur J Cancer 2013; 49(18): 3821-30. http://dx.doi.org/10.1016/j.ejca.2013.09.026

Francini E, Petrioli R, Roviello G. No clear evidence of a clinical benefit of a sequential therapy regimen with abiraterone acetate and enzalutamide. Expert Rev Anticancer Ther 2014; 14(10): 1135-40. http://dx.doi.org/10.1586/14737140.2014.949677

Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013; 369(3): 213-23. http://dx.doi.org/10.1056/NEJMoa1213755

Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 2010; 363(5): 411-22. http://dx.doi.org/10.1056/NEJMoa1001294

Singh AN, Khandwekar AP, Sharma N. Cancer Stem-Cell Related miRNAs: Novel Potential Targets for Metastatic Prostate Cancer. Journal of Analytical Oncology 2015; 146-56.




How to Cite

Jamal Zekri, Ayman Ramadan, Muthu Kumar, & Rasha Haggag. (2016). Abiraterone Acetate in Patients with Advanced Castrate Resistant Prostate Cancer: Initial Real Life Experience in 2 Cancer Units. Journal of Analytical Oncology, 5(1),  42–46. https://doi.org/10.6000/1927-7229.2016.05.01.6




Most read articles by the same author(s)