Right treatment sequence of Abiraterone Acetate-Prednisone and Enzalutamide for Prostate Cancer

A study published in “Cancer Treatment Reviews” demonstrated that in castration-resistant metastatic prostate cancer (mCRPC) patients, abiraterone acetate plus prednisone (AAP) given as the first-line therapy followed by enzalutamide has significant clinical efficacy in delaying disease advancement when compared to enzalutamid followed by AAP sequence.

J Cassinello et al. undertook this systematic review and meta-analysis to investigate the effect of the hormonal therapy sequencing including AAP and enzalutamide for managing mCRPC, and determine which sequence offers more advantages to the patients. In EMBASE and PubMed electronic databases, the studies published in English that explored the efficacy of therapy sequences, based on AAP and enzalutamid in mCRPC patients were identified. Notably, 17 studies fulfilled the inclusion criteria of the study.

Two studies assessed both the treatment sequences (AAP followed by enzalutamid and enzalutamid followed by AAP). The investigators found that the sequence of AAP followed by enzalutamid displayed substantially longer prostate specific antigen-progression free survival compared to enzalutamid followed by AAP. The nine studies evaluating Doc followed by AAP followed by enzalutamid sequence illustrated promising outcomes regarding progression free survival.

Five studies that assessed AAP followed by enzalutamid sequence demonstrate a decline in prostate-specific antigen levels ≥ 50% in 11-41% of subjects treated with enzalutamide after prior therapy with AAP.

In the two studies that analyzed the Doc followed by enzalutamid followed by the AAP sequence, the prostate-specific antigen response rates were much reduced compared to that reported with Doc followed by AAP followed by enzalutamid, with a decline in prostate-specific antigen ≥ 30 of 3-18% and prostate-specific antigen ≥ 50 of 8-11%. But, more robust studies and randomized trials are required to validate the best therapy sequencing, concluded the authors.

Also read Abiraterone acetate for management of prostate cancer.