Het effect van maagzuurremmende geneesmiddelen op de behandeluitkomst met abirateronacetaat in patiënten met gemetastaseerde castratieresistente prostaatkanker. (Dutch/Flemish)

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    • Alternate Title:
      The effect of acid reducing agents on treatment outcome with abiraterone acetate in patients with metastatic castrationresistant prostate cancer. (English)
    • Abstract:
      Abiraterone acetate is registered for pre- and postchemotherapy treatment in patients with metastatic castrationresistant prostate cancer (mCRPC). Abiraterone acetate shows poor bioavailability and the solubility rapidly declines at pH > 1. Acid reducing agents (ARA's), e.g. proton pump inhibitors, H2 antagonists, or antacids, may affect abiraterone uptake due to the poor solubility of abiraterone acetate at pH exceeding 1. The exposure to abiraterone is critical since a relation between abiraterone exposure, PSA decrease and overall survival was shown in patients treated with this drug. OBJECTIVE To investigate whether acid reducing agents have an effect on the efficacy of abiraterone acetate in patients with mCRPC. DESIGN AND METHODS In this retrospective database study, mCRPC-patients who started treatment with abiraterone acetate in the Radboudumc, Nijmegen from September 2011 till May 2016 were identified. Data e.g. use of abiraterone, co-medication, use of acid reducing agents, and PSA were collected. PSA progression, progression-free survival, time to nadir PSA, PSA in week 12, and reaching 50 percent decrease in PSA are compared in patients pre- and postchemotherapy with or without acid reducing agents during therapy with abiraterone acetate. RESULTS No difference in outcome is shown for PSA progression in patients in time with or without ARA's prechemotherapy (9.0 versus 8.5 months; hazard ratio [HR] 0.9, 95% confidence interval [95%-CI] 0.6-1.6) and postchemotherapy (8.2 versus 8.0; HR 1.3, 95%-CI 0.5-3.3). Progression-free survival, time to nadir PSA, PSA in week 12, and reaching 50 percent decrease in PSA did not show statistically significant differences. CONCLUSION The use of acid reducing agents is not associated with a decreased effect of abiraterone acetate in patients with metastatic castration-resistant prostate cancer. [ABSTRACT FROM AUTHOR]
    • Abstract:
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