Abiraterone

What is abiraterone?

Abiraterone acetate (Zytiga®) is a type of hormone therapy for men with prostate cancer that has spread to other parts of the body (advanced prostate cancer) and has stopped responding to other types of hormone therapy. You may hear it called second-line therapy.

It works by stopping the body producing a hormone called testosterone. But it does this in a different way to other types of hormone therapy. In most men, prostate cancer cells can’t grow without testosterone, even if they have spread to other parts of the body.

Abiraterone won’t cure your prostate cancer, but it can help keep it under control and has been shown to help some men live longer. It can also help to treat or delay symptoms, such as pain and tiredness.

Who can have abiraterone?

Abiraterone is suitable for men with advanced prostate cancer that has stopped responding to other types of hormone therapy. You may hear this called hormone-relapsed or castrate resistant prostate cancer. You can have abiraterone before or after chemotherapy.

Your hospital doctor may offer you abiraterone if you can’t have chemotherapy, or you don’t want to have it yet. Abiraterone may be suitable if you have no symptoms or mild symptoms.

Or you may be offered abiraterone if you’ve had chemotherapy with a drug called docetaxel, and your cancer has stopped responding to this treatment.

If you’ve already had a type of hormone therapy called enzalutamide, abiraterone probably won’t be an option. And if you’ve already had abiraterone, enzalutamide probably won’t be an option. This is because research suggests that men who have already had one of these drugs don’t respond so well to the other drug. However, if you get severe side effects from abiraterone or enzalutamide, you may be able to try the other drug.

If you're having trouble getting abiraterone, even though your doctor thinks it is suitable for you, please let us know.

Earlier abiraterone

There is evidence that abiraterone may benefit some men at an earlier stage, when they are first diagnosed with advanced prostate cancer. It isn’t available on the NHS, or through the Health and Social Care (HSC) service in Northern Ireland, for these men. The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) will be looking at whether abiraterone should be available for some of these men. You can read more about this on our What we think and do page. Until then, men who have just been diagnosed with advanced prostate cancer may be able to have abiraterone earlier if they pay for treatment or have private medical insurance.

Abiraterone or enzalutide?

Abiraterone and enzalutamide are both types of hormone therapy that treat advanced prostate cancer.

Your hospital doctor will talk to you about which drug is most suitable for you. For example, abiraterone may be a better option than enzalutamide if you’ve had:

any falls
any seizures (fits) or you have an increased risk of seizures
extreme tiredness (fatigue)
problems with memory or concentration.

This is because enzalutamide can increase your risk of these problems.

But enzalutamide may be a better option than abiraterone if your cancer has spread to the liver or lungs, or if you can’t take steroids. Abiraterone must be taken with a steroid.

Some men prefer to take abiraterone because it is less likely to cause tiredness than enzalutamide. But some men find enzalutamide easier to take because, unlike abiraterone, you don’t need to take it on an empty stomach and you don’t need to take steroids.

Speak to your doctor or specialist nurse about which treatments might be suitable for you and when to have them. You can also talk things through with our Specialist Nurses.

Other health problems and medicines

Tell your doctor about any other health problems you have. You should also tell them about any other medicines you’re taking or have taken recently, including any painkillers, such as tramadol. This is because abiraterone may affect how other medicines work. And some medicines can affect how well abiraterone works. Your doctor will talk to you about which prostate cancer treatment would be best for you.

If you have heart or liver problems, you may not be able to take abiraterone. If you have high blood pressure or a low level of potassium in your blood, you may need treatment for these before you start taking abiraterone.

If you have diabetes, the steroids that you need to take alongside abiraterone may increase your risk of high blood sugar levels. Your doctor or nurse may advise you to check your blood sugar levels more regularly than usual. If you take tablets or insulin to treat your diabetes, your doctor may suggest taking enzalutamide instead of abiraterone.
Other treatment options
If abiraterone isn’t suitable for you, or if you choose not to have it, your doctor may offer you a different treatment. Possible treatments include:
- enzalutamide
- chemotherapy (docetaxel or cabazitaxel)
- steroids
- radium-223
- less commonly, oestrogens.
Speak to your doctor about your treatment options. They can also tell you about any clinical trials that might be suitable for you.

Read more about treatment options after your first hormone therapy.

What does treatment involve?

Abiraterone is usually taken as two tablets, once a day. Swallow the tablets whole with water. It’s important not to chew, break or crush the tablets.

You should take the tablets on an empty stomach, at least two hours after eating. You shouldn’t eat anything for at least one hour after taking the tablets. This is because food can affect the way your body absorbs abiraterone. You could take the tablets an hour before breakfast.

You will also take a steroid called prednisolone or prednisone, usually as a tablet twice a day with food. This lowers the risk of some side effects.

You will probably continue with your first type of hormone therapy, even though it’s stopped working so well. For most men, this will be a monthly or three-monthly injection. This will still help to keep the amount of testosterone in your body low and may help abiraterone to work. Read more about what happens when your first hormone therapy isn’t working so well.

What are the side effects?

Like all treatments, abiraterone can cause side effects. These may affect each man differently, and you’re unlikely to get all the possible side effects. Before you start treatment, your doctor or nurse will explain the possible side effects. Knowing what to expect can help you deal with them. You can find more information in the leaflet that comes with your medicine or from the Electronic Medicines Compendium.

Common side effects include:

a build-up of fluid in your body (fluid retention), which can cause swelling in your legs or feet
a drop in the level of potassium in your blood, which can cause weakness or twitches in your muscles, or a fast, pounding heartbeat – speak to your doctor straight away if you notice these symptoms
liver problems
high blood pressure.

Less common side effects include:

high levels of fat in your blood
chest pain
heart problems
severe infections
indigestion
blood in your urine
skin rashes
broken bones.

Your doctor will check your blood pressure and give you regular blood tests while you are taking abiraterone to check for any problems with your heart, liver or potassium levels.

Taking a steroid together with abiraterone lowers the risk of some side effects, such as high blood pressure, having too much water in your body and a lower level of potassium in your blood. But steroids can cause other side effects.

Taking abiraterone may cause your bones to get thinner and weaker over time. You can help keep your bones strong and reduce your risk of severe bone thinning (osteoporosis) by making changes to your lifestyle. If you already have osteoporosis, your doctor may suggest taking medicines, such as bisphosphonates, to help reduce the risk of broken bones.

Speak to your doctor or specialist nurse if you have any side effects from taking abiraterone, even if they’re not listed here. They may offer you other treatments to help manage any side effects.

Contraception

If you’re sexually active and there is a chance your partner could become pregnant, use a condom together with another form of contraception while you are taking abiraterone and for three months after. If your partner is pregnant, you should use a condom if you have sex, as abiraterone could harm the baby.

What happens next?

You may have a prostate specific antigen (PSA) blood test at least every two or three months while you’re taking abiraterone to check how well your treatment is working. You may also have blood tests to check for any problems with your potassium levels or liver, as well as blood pressure checks about once a month. Ask your doctor which tests you will have and how often you’ll have them.

Your PSA levels alone aren’t usually enough to know if your treatment is working. Your doctor will use your PSA level and any other test results, along with information about how you’re feeling, to check how well the treatment is working. Tell your doctor or nurse about any side effects you’re having, as there may be ways of managing these.

If your PSA level falls, this usually suggests your treatment is working. How quickly the PSA level falls, and how low, will vary from man to man.

In some men, the PSA level won’t fall. This alone doesn’t mean that abiraterone isn’t working. Your doctor will also ask you about any symptoms you’re having. You may have scans, such as an MRI scan or CT scan, particularly if your PSA level is rising. Your doctor may suggest you keep taking abiraterone or, if they’re concerned the cancer is growing, they may talk to you about other treatment options.

For more information about abiraterone, speak to your hospital doctor or specialist nurse, or to our Specialist Nurses.

References

Updated: March 2018 | Due for Review: March 2020

List of references
- Basch E et al. Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naïve men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial. Lancet Oncol. 2013; 14: 1193-1199.
- Electronic medicines compendium. Patient information leaflet: Xtandi 40mg soft capsules. 2017. Available from: https://www.medicines.org.uk/emc/medicine/27913 [Accessed 21 September 2017]
- Electronic medicines compendium. Patient information leaflet: Zytiga. Available from: https://www.medicines.org.uk/emc/search 2017 [Accessed 11 September 2017]
- Fizazi K et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. 2017; 377(4): 352-360.
- Fizazi K, Scher HI, Molina A, Logothetis CJ, Chi KN, Jones RJ, et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2012 Oct;13(10):983–92.
- Galletti G et al. Mechanisms of resistance to systemic therapy in metastatic castration-resistant prostate cancer. Cancer Treatment Reviews 2017; 57: 16-27.
- Gillessen S et al. Management of patients with advanced prostate cancer: the report of the advanced prostate cancer consensus conference APCCC 2017. Eur Urol 2017 (In press)
- James ND et al. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017; 377: 338-351.
- Joint Formulary Committee. British National Formulary: Abiraterone acetate. London: BMJ Group and Pharmaceutical Press. 2017.
- Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P, et al. EAU-ESTRO-ESUR-SIOG Guidelines on prostate cancer. European Association of Urology; 2017.
- National Institute for Health and Care Excellence. Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Technology appraisal guidance [TA387]. 2016.
- National Institute for Health and Care Excellence. Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen. Technology appraisal guidance [TA259]. 2016.
- National Institute for Health and Care Excellence. Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Technology appraisal guidance [TA377]. 2016.
- National Institute for Health and Care Excellence. Enzalutamide for metastatic hormone relapsed prostate cancer previously treated with a docetaxel containing regimen. Technology appraisal guidance [TA316]. 2014.
- Ritch CR, Cookson MS. Advances in the management of castration resistant prostate cancer. BMJ 2016; 355: i4405.
- Ryan CJ et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2015; 16: 152–60.
- Scottish Medicines Consortium. Abiraterone acetate 250mg tablets (Zytiga®). SMC No. 873/13 [Internet]. 2015. Available from: https://www.scottishmedicines.org.uk/files/advice/abiraterone__Zytiga__IRP_FINAL_Sept_2015_for_website.pdf [Accessed 11 September 2017]
- Scottish Medicines Consortium. Abiraterone acetate 250mg tablets (Zytiga®) SMC No. (764/12) [Internet]. 2012. Available from: https://www.scottishmedicines.org.uk/files/advice/abiraterone_Zytiga_RESUBMISSION_FINAL_July_2012_Amended_For_website.pdf [Accessed 11 September 2017]
- Zhang W et al. Indirect comparison between abiraterone acetate and enzalutamide for the treatment of metastatic castration resistant prostate cancer: a systematic review. Asian Journal of Andrology 2017; 19: 196–202.