ADT + Abiraterone + Methylprednisolone Combination Therapy

The combination "ADT + abiraterone + methylprednisolone" refers to a therapeutic regimen used primarily for treating metastatic prostate cancer. This combination consists of androgen deprivation therapy (ADT), abiraterone acetate, and methylprednisolone. ## Components of the Combination **Androgen Deprivation Therapy (ADT)** is the mainstay treatment for metastatic prostate cancer. It works by reducing androgen levels in the body, which can slow the growth of prostate cancer cells that depend on androgens for proliferation. **Abiraterone acetate** (brand names include Zytiga, Yonsa) is an antiandrogen medication that inhibits 17 α-hydroxylase/C17,20-lyase (CYP17), an enzyme expressed in testicular, adrenal, and prostatic tumor tissues. This inhibition regulates androgen biosynthesis, further suppressing testosterone production beyond what ADT alone can achieve. **Methylprednisolone** is a corticosteroid that is used in this combination to reduce the adverse events caused by increased mineralocorticoid production that can occur with abiraterone treatment. It can also provide additional benefits for pain management in cancer patients. ## Clinical Use and Evidence This combination therapy has shown significant clinical benefits in treating metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC). Clinical trials have demonstrated that adding abiraterone to ADT results in prolonged progression-free survival and overall survival compared to ADT alone. The PEACE-1 trial specifically examined the combination of ADT with abiraterone and docetaxel, showing significant benefits, although this specific combination is not FDA-approved. Other trials like STAMPEDE and LATITUDE have also shown benefits of combining ADT with abiraterone. ## Administration The recommended dose of abiraterone is typically 1,000 mg orally once daily, given in combination with a corticosteroid (prednisone 5 mg or 10 mg, or methylprednisolone at equivalent doses) to reduce adverse events caused by increased mineralocorticoid production. ## Side Effects and Considerations The combination therapy increases the risk of grade III to V adverse events compared to ADT alone. Common side effects include tiredness, vomiting, headache, joint pain, high blood pressure, swelling, low blood potassium, high blood sugar, hot flashes, diarrhea, and cough. More severe side effects may include liver failure and adrenocortical insufficiency. The treatment decision should consider the patient's overall health status, disease severity, and potential for drug-drug interactions, especially in older patients with comorbidities. It's worth noting that abiraterone tablets should not be handled by pregnant women or women who may become pregnant, as the medication can harm an unborn baby or cause miscarriage.

Brand names

ZytigaMedrol

Other names

Enhanced SST using Abiraterone + MethylprednisoloneADT + Abiraterone + Methylprednisolone