"I think the micronized formulation is something to think about," says Gautam Jayram, MD.
Urology Times’ Evolving Paradigms Roundtable programs feature expert-led peer discussion of key topics in urology. A recent roundtable involved discussion surrounding management considerations and treatment selection for special populations with metastatic castration-resistant prostate cancer (mCRPC). In an excerpt from this program, moderator Gautam Jayram, MD, discusses the 2 formulations for the prostate cancer treatment abiraterone (abi) acetate (Zytiga and Yonsa). Jayram is a urologist with Urology Associates PC in Nashville, Tennessee.
The following transcription was AI generated and edited for length and clarity.
Gautam Jayram, MD
Jayram: One of the things that…is interesting, and this is something that a lot of people I don’t think realize, is that abi has 2 formulations. There’s your traditional abi 1000 mg daily with prednisone, and then there’s micronized abi. It’s a small-particle abiraterone; the trade name is Yonsa. It’s given with methylprednisolone, which is a little bit of a stronger steroid than prednisone.... I don’t know if you folks talk about this a lot with your patients. Our pharmacists definitely do, and I…have started a little bit, but abi is meant to be taken on an empty stomach because if you take it on a full stomach, you can really supercharge the absorption of the abiraterone. The label says to take it an hour before you eat or 2 hours after you eat, and that can be problematic for patients who maybe don’t pay attention. [Perhaps] they’ve got 20 medications; maybe they have weird eating habits. Yonsa actually bypasses all of that because it’s micronized particles, and it doesn’t matter at all how you take it. So I think that’s an important thing that maybe some people don’t realize…[there are 2] abiraterone formulations.
[I want to talk more about] this concept of the micronized formulation of abi. [There was] a seminal study, [whose data helped get] Yonsa approved, where [the investigators]…proved that the fine-particle abi is basically equivalent to traditional oral abi.1 They treated patients with both, and they compared their T levels after 7 weeks, and they found that they were the same. So if you [took] Yonsa vs oral abi, they found that you have the same drop in your T levels, which, as we know, is a really good surrogate for efficacy in these drugs. And then you see the same PSA50 [prostate-specific antigen reduction of 50%] response...it’s very, very similar.... We have so [many] robust data with abi; there are so [many] data that show how great of a drug abi is.... If you’re going to consider putting people on micronized abi, it’s clear that it’s a very similar drug.
[Regarding safety,]...this was surprising to me. Musculoskeletal and connective tissue disorders were less frequent, almost by a factor of 3 [in patients receiving micronized abi], so quite a bit less musculoskeletal pain. It seems [that] this group doesn’t have a ton of musculoskeletal pain, so I don’t want to beat a dead horse. I see this a decent amount, especially in my younger patients.... They complain about this. It may not be…really severe, but they complain about this.... So I think the micronized formulation is something to think about. Equivalency studies [were conducted] to [evaluate before] chemo[therapy] and post chemo[therapy whether] we [would] see similar data to the original abi. And [the findings] have shown that. So the efficacy is there; I think the safety is better. The micronized abi…is something that should be considered…. Is there value in having it in your [in-office
dispensary]? Is there value in offering it to patients? I think if everything were equal and access were equal, it would probably be the preferred abiraterone.
REFERENCE
1. Stein CA, Levin R, Given R, et al. Randomized phase 2 therapeutic equivalence study of abiraterone acetate fine particle formulation vs. originator abiraterone acetate in patients with metastatic castration-resistant prostate cancer: the STAAR study. Urol Oncol. 2018;36(2):81.e9-81.e16. doi:10.1016/j.urolonc.2017.10.018
Dr. Richard Matulewicz discusses smoking cessation counseling and treatment among urologists
March 31st 2021“Because so many disease processes that we deal with are related to tobacco use and smoking specifically… I think this is absolutely our domain,” says Richard S. Matulewicz, MD, of tobacco cessation counseling and treatment.