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Treatment Name: Abiraterone (Zytiga®) + Prednisone

Abiraterone (Zytiga®) + Prednisone is a Chemotherapy Regimen for Prostate Cancer

How does Abiraterone + Prednisone work?
The medications, Abiraterone and Prednisone, are designed to slow the growth of prostate cancer cells and stop them from becoming larger.  Abiraterone + Prednisone work by decreasing the production of testosterone and other steroids, known as androgens, that are made by your body in three places: the testes, adrenal glands, and prostate tumors. 

Goals of therapy:
Abiraterone + prednisone is taken to slow the progression of prostate cancer and shrink the size of tumors.  This treatment may not cure the disease, but has been shown to prolong survival and decrease associated symptoms. 

Schedule

Common abiraterone (Zytiga®) starting Dose:

  • Abiraterone (Zytiga®) 1000 mg (two 500 mg tablets OR four 250 mg tablets) swallowed whole, by mouth once daily on an empty stomach (1 hour before or 2 hours after food)
  • Prednisone 5 mg by mouth twice daily with food

Abiraterone and Prednisone are dispensed by a pharmacy and taken at home.

Typical duration of therapy is until the medication no longer works or until side effects make it so that it is difficult to take the medication.  Talk to your doctor if you cannot tolerate the medications.

Side Effects

In clinical studies the most commonly reported side effects with abiraterone + prednisone are shown here. Side effects sometimes have percentage ranges [example: 39 - 44% fatigue] because they differed between clinical studies.

  • High blood triglycerides (63%)
  • High blood sugar (57%)
  • Fatigue, or tiredness (39 - 44%)
  • Back pain (30 - 32%)
  • Edema, or general swelling (28 - 31%)
  • Joint swelling (30%)
  • Nausea (22 - 30%)
  • Joint pain (27 - 28%)
  • Low blood potassium (17 - 28%)
  • Constipation (23 - 26%)
  • Anemia [low red blood cell count] (23%)
  • Hot Flushing (19 - 22%)
  • Diarrhea (18 - 22%)
  • High blood pressure (10 - 22%)
  • Vomiting (21%)
  • Urinary tract infection (12%)

Side effect videos Side Effect Videos
Fatigue Fatigue PainPainNausea and VomitingNausea and VomitingConstipationConstipationAnemiaAnemiaDiarrheaDiarrhea

Monitoring

How often is monitoring needed?  
Labs (blood tests) may be checked monthly before starting a new cycle of treatment.  Liver function tests may be checked every two weeks for the first three months and then monthly thereafter.  Labs often include: prostate specific antigen (PSA), Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood sugar level, blood pressure plus any others your doctor may order.

How often is imaging needed? 
Imaging such as an X-ray and/or bone scans may be done before treatment and at regular intervals during treatment.

How might blood test results/imaging affect treatment? 
Depending upon the results  your doctor may advise to continue this treatment as planned, or delay, or switch therapy.

ChemoExperts Tips

  • Avoid eating food at least two hours before or at least one hour after taking a dose.  Food increases exposure, or uptake, to this medication and may cause more side effects
  • Adrenal problems may occur if prednisone is discontinued, the patient gets an infection, or is under stress
  • Notify your doctor if you have any signs of urinary tract infection, such as painful or frequent urination or the urge to urinate with little urine coming out
  • Abiraterone may cause a drop in blood potassium levels; talk to your doctor about how to monitor and treat low potassium
  • Some medications, known as CYP3A4 inducers, CYP2C8 subtrates, and CYP2C6 substrates, may interact with Abiraterone
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for prostate cancer.  Ask your doctor if any studies are currently enrolling in your area.  If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Abiraterone (Zytiga®) + Prednisone, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Abiraterone (Zytiga®) + Prednisone. Depending upon your income, they may be able to help cover the cost of:

  • Abiraterone
  • Pred­nisone

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Abiraterone (Zytiga®) + Prednisone and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Abiraterone (Zytiga®) + Prednisone

Individual Drug Label Information

Abiraterone (Zytiga®)

  • Abiraterone film-coated tablets are available in two strengths: an oval, pink oral tablet (250 mg strength) and an oval, purple oral tablet (500 mg strength)
  • Abiraterone uncoated tablets are available in one strength: an oval white oral tablet (250 mg strength)
  • The typical dose is 1000 mg once daily, using either four 250 mg tablets, OR two 500 mg tablets
  • Abiraterone is usually taken by mouth on an empty stomach. Tablets should be swallowed whole with a large glass of water and at the same time each day
  • Food increases absorption so it is best to take on an empty stomach to avoid extra absorption and increased side effects
  • If you miss an abiraterone dose, take your regular dose the following day. If more than one dose is missed talk to your doctor
  • Sexually active patients should use a condom and a second form of contraception during and one week after treatment
  • Pregnant women or women of child bearing age should NOT swallow or handle tablets without wearing gloves
  • Store abiraterone at controlled room temperature 68°F to 77°F (or 20°C to 25°C); excursions permitted in the range from 59°F to 86°F (15°C to 30°C)
  • Dosage adjustments may be required for increased liver function tests or if coadministration of CYP 3A4 inducers is required
  • Abiraterone may interact with CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine, rifebutin, rifapentine, phenobarbital) CYP2D6 substrates (e.g., dextromethorphan, thioridazine), and CYP2D8 substrates (e.g., pioglitazone). You may need a dose adjustment while on these medications. Speak with your doctor or pharmacist before starting one of these medications
General Abiraterone Side Effects
  • High blood triglycerides
  • High blood sugar
  • Fatigue (tiredness)
  • Back pain
  • Joint swelling
  • Joint pain
  • Edema
  • Low red blood cells (anemia)
  • Nausea
  • Constipation
  • Vomiting
  • Hot Flushing or hot flash
  • Diarrhea
  • Low blood potassium
  • High blood pressure
  • Urinary tract infection
  • Click on the abiraterone (Zytiga) "See DailyMed package insert" link below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

Pred­nisone (Deltasone®)

  • Prednisone is an oral medication, usually supplied as a white tablet
  • Prednisone may increase the risk of infection. Depending upon how much prednisone is taken, antibiotics may be prescribed to help prevent infections during treatment with prednisone
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 P.M. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of prednisone may need to be gradually decreased to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Prednisone Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the Prednisone package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

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References

1. Ryan CJ, Smith MR, de Bono JS, et al. Randomized Phase 3 Trial of Abiraterone Acetate in Men with Metastatic Castration-Resistant Prostate Cancer and No Prior Chemotherapy. N Engl J Med. 2013;368:138-148.

2. de Bono JS, Logothetis CJ, Molina A, et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011;364:1995-2005.

Created: August 18, 2015 Updated: September 5, 2018

What is Prostate Cancer?

A disease of the cells found in the prostate gland in men.  Prostate cancer is a common condition caused by abnormal growth and rate changes in the prostate gland cells that form tumors.  The stage of prostate cancer can vary at diagnosis and throughout treatment.  The staging includes both the TNM + Grade, which is based on exam of tissue removed by surgery, and clinical staging: Stage I, IIa, IIb, III, IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.