PGY2 Oncology Pharmacy Resident Froedtert & Medical College of Wisconsin Milwaukee, Wisconsin, United States
Poster Abstract:
Background: Abiraterone and docetaxel are considered standard of care in nearly all stages of advanced prostate cancer treatment. For patients on abiraterone, prednisone is prescribed to reduce the risk of mineralocorticoid excess that results from abiraterone’s inhibition of glucocorticoid production. Patients receiving docetaxel for metastatic castrate resistant prostate cancer (mCRPC) are given prednisone for its modest antitumor activity. Prednisone dosing for patients on these agents is not universal, and the dose varies based on disease staging. Currently at Froedtert & Medical College of Wisconsin, nearly all patients started on abiraterone or docetaxel are started on prednisone 5 mg twice daily, regardless of the patient’s stage of disease. This puts metastatic castrate sensitive prostate cancer (mCSPC) patients and those with localized advanced disease at risk of long term excessive steroid exposure, which can lead to increased blood pressure, metabolic changes, and increased risk of bone fracture, among others. The goal of this project is to standardize prednisone dosing for all patients started on abiraterone and/or docetaxel through the use of a collaborative practice agreement (CPA). This CPA would allow outpatient oncology pharmacists to identify patients starting on abiraterone and/or docetaxel, and to adjust prednisone dosing to align with NCCN guidelines and reduce unnecessary steroid exposure.
Objectives: The primary outcome is to evaluate the impact of a pharmacist driven prednisone dosing CPA. The secondary objective is to evaluate the safety outcomes of a pharmacist driven prednisone dosing CPA by assessing laboratory values related to mineralocorticoid excess (such as potassium, blood pressure, and fluid status) in addition to trends in blood glucose.
Results: Results Pending
Conclusions/
Discussion: Results Pending
References (must also be included in final poster): 1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer Version 2.2023. 2. Ndibe C, Wang C, Sonpavde G. Corticosteroids in the Management of Prostate Cancer: A Critical Review. Curr.Treat. Options in Oncol. 2015 Feb;16(2):6. doi: 10.1007/s11864-014-0320-6. 3. Teply BA, Luber B, Denmeade SR, Antonarakis ES. The influence of prednisone on the efficacy of docetaxel in men with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2016;19(1):72-78. doi:10.1038/pcan.2015.53 4. Attard G, Merseburger AS, Arlt W, et.al. Assessment of the Safety of Glucocorticoid Regimens in Combination With Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer: A Randomized, Open-label Phase 2 Study. JAMA Oncol. 2019 Aug 1;5(8):1159-1167. doi: 10.1001/jamaoncol.2019.1011.Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer 5. James N, Bono J, Spears M et.al. Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 2017; 377:338-351. DOI: 10.1056/NEJMoa1702900 6. Bradford J, White A, Scarpati L, et.al. Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review. 2017;(2216-2229). doi.org/10.1016/j.clinthera.2017.09.011
