Investigator Perspectives on Emerging Concepts in the Management of Genitourinary CancersSequencing abiraterone and enzalutamide in mCRPC
2:08 minutes.
TRANSCRIPTION:
DR LOVE: How do you choose between the 2 secondary hormonal therapies, abiraterone and enzalutamide? Which one do you generally use first? DR GEORGE: We’re an academic research medical center, so if we’ve got a clinical trial that’s going to ask a question around the field, we’re going to participate in that. And we have both investigator-initiated studies as well as cooperative group studies. But to really answer your question for off-study patients, I don’t think we have any head-to-head data to suggest that one is better than the other. So I feel fairly equitable at choosing 1 agent or the other based upon side-effect profiles and what I think the patient will tolerate. Some of the things I look at are if patients have significant comorbidities I think could be affected by prednisone use, such as diabetes, if they’ve got issues with significant cardiac complications that I’m worried about prednisone in. And then I’d steer a little bit more toward enzalutamide. I am a little bit concerned about the incidence of falls associated with enzalutamide, particularly in the very elderly patients, patients over 75 or 80. And so that’s a population where I might steer a little bit more toward abiraterone/prednisone. But, I’d say, by and large, both of these drugs are pretty well tolerated, and I feel pretty lucky that we have 2 good choices. I think for a lot of our patients, these kinds of factors aren’t an issue for either one. And there, I feel pretty comfortable with either agent. I probably use a little bit more enzalutamide than abiraterone when all things are equal, because of the lack of prednisone associated with that, and because of, I think, a little bit more of the specificity of the mechanism, specifically on the androgen receptor. But I don’t have any really good strong clinical data to say that’s going to be a more efficacious path than abiraterone. |