By Rachael Babin.
Patients with advanced metastatic prostate cancer have been given new hope by changes to PBS eligibility criteria.
Patients whose disease has progressed after hormone therapy but are deemed unsuitable for chemotherapy treatment can now access subsidised abiraterone acetate, as part of a raft of changes to PBS-listed treatment options active from December 1st.
Previously patients had to undergo chemotherapy treatment in order to qualify for subsidised access, resulting in fewer treatment options for those not suitable to receive docetaxel, for example when chemotherapy is contraindicated due to the patient’s age or frailty, other health ailments or medication use.
Removal of the need to demonstrate actual intolerance to chemotherapy before becoming eligible for subsidised access to abiraterone has been welcomed by the Prostate Cancer Foundation of Australia (PCFA). Associate Professor Anthony Lowe, CEO of the PCFA, told OncologyNews, “many men who have castrate resistant metastatic prostate cancer are either too frail or otherwise unsuitable for chemotherapy, so allowing affordable access to abiraterone on the basis of predicted (as opposed to actual) intolerance will make a huge difference.
“Without the change there would be very limited options for men in this situation.”
The PCFA have been advocating for abiraterone to be more widely available ever since it was first listed in August last year.
Abiraterone in combination with prednisone has been shown to improve median overall survival, prolong median radiographic progression-free survival, delay PSA progression and the need for opiate use for cancer-related pain in patients with advanced prostate cancer who are no longer responding to hormone therapy, but who have not undergone chemotherapy, compared with placebo and prednisone.(1,2)
Abiraterone is an androgen biosynthesis inhibitor which hinders the production of androgens at all three sources – the adrenal glands, testes and the tumour itself – essentially depriving cancer cells of androgen hormone which stimulates their growth.
Associate Professor Lowe also welcomed other changes to prostate cancer treatment eligibilities noting, “it is also good to see that patients who have received treatment with abiraterone through the PBS will now be eligible for PBS-subsidised docetaxel if required at a later date.”
In reflecting upon developments in prostate cancer treatments, Associate Professor Lowe also told OncologyNews that, ‘”it is pleasing to see four new therapies for advanced prostate cancer listed on PBS in the past two or so years. It is important that options are available because some patients may respond well to one particular drug but not another. In addition, we anticipate that used in combination the new drugs will revolutionise the treatment of advanced prostate cancer offering new hope to men and their families.”
1. Ryan CJ, Matthew MD, et al. Abiraterone in metastatic prostate cancer without previous chemotherapy. New England Journal of Medicine, 2013;368:138-48.
2. Rathkopf DE, Smith MR, et al. Updated interim analysis (IA) of COU-AA-302, a randomized phase III study of abiraterone acetate (AA) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) without prior chemotherapy. J Clin Oncol (Meeting Abstracts) February 2013 vol. 31 no. 6_suppl