The prostate gland is an important lifeline for men, and prostate cancer is the “silent killer” of men’s health, and is currently the second most common malignancy in men worldwide. The 5-year survival rate for prostate cancer is nearly 100% in the early stages before metastasis occurs, while the 5-year survival rate for metastatic prostate cancer is only 28%, so once prostate cancer is diagnosed, patients should be proactive in their treatment.
Patients progress to destructive resistant prostate cancer (i.e., androgen blockade therapy is ineffective) after 18-24 months of conventional endocrine therapy; when the tumor metastasizes to organs other than the prostate, the disease progresses to metastatic destructive resistant prostate cancer (mCRPC). In the mCRPC stage, the tumor cells themselves secrete androgens that contribute to continued tumor growth, making it particularly important to block all sources of androgens in the treatment of prostate cancer. Traditional endocrine therapy blocks androgens from the testes and adrenal glands, but not from the prostate cancer cells themselves. Abiraterone, a new endocrine therapy drug, is an androgen biosynthetic enzyme inhibitor that can block all sources of androgens from testes, adrenal glands and tumor cells, inhibit tumor growth and effectively treat metastatic destructive resistant prostate cancer.
In January 2016, the “Zephyr Life Assistance Program”, initiated by the China Primary Health Care Foundation with assistance from Xi’an Janssen Pharmaceutical Co. “, ensures that prostate cancer patients in mainland China can receive standardized treatment, improve the accessibility of treatment, reduce family burden, improve quality of life and prolong life.
1.Monitoring matters during abiraterone administration
2.Dose adjustment in case of hepatic and renal impairment
2 Patients with mild hepatic impairment at baseline do not require dose adjustment
2 For patients with moderate hepatic impairment at baseline (Child-Pugh class B), the recommended dose is reduced to 250 mg qd + 5 mg bid prednisone
2 Zecorò should not be used in patients with severe hepatic impairment (Child-Pugh Class C)
2 In patients with renal impairment, no dose adjustment is required. However, there is no clinical experience in patients with prostate cancer with severe renal impairment, and caution is advised in such patients
3. Dose adjustment for patients with hepatotoxicity occurring during abiraterone treatment
During the course of drug administration, do regular monitoring of blood potassium, liver and kidney function, blood pressure, blood routine and other indicators, adverse reactions are mild and controllable. Elevated PSA alone should still be continued, combined with comprehensive assessment of imaging and clinical symptoms. For patients with mCRPC, abiraterone is the obvious choice.
4. Instructions and precautions for the use of abiraterone.
2 The recommended dose of abiraterone is 1,000 mg (4*250 mg tablets) orally once daily and requires co-treatment with prednisone, prednisone 5 mg orally twice daily.
2 Abiraterone must be taken on an empty stomach with a fast at least 2 hours before and 1 hour after administration of abiraterone acetate (Zecor).
2 The tablet must be delivered whole with water and not crushed or chewed.
2 Abiraterone should not be used in patients with severe hepatic impairment (Child-Pugh Class C) at baseline.
5. How can I predict the effect of treatment before taking the drug? A recent international study provides a predictive tool with 70% accuracy.
Common clinical information is first collected prior to treatment.
2. whether lactate dehydrogenase is greater than normal
2. whether physical status is inadequate for daily living
2. whether there are liver metastases
2. whether albumin is less than 4 g/dl
2. whether alkaline phosphatase is greater than normal
2. whether conventional endocrine therapy has been effective for less than 3 years prior to treatment.
Note that a “yes” answer for each of the above choices indicates that long-term survival after abiraterone therapy is not promising.
For patients taking abiraterone after chemotherapy, the summary is.
0-1 “yes”, with an average survival of 2 years.
2-3 “yes”, with an average survival of 1 year
4-6 “yes” for an average survival of six months.
It is worth noting that high PSA values are not used as a predictor of abiraterone efficacy.