Liver Function Abnormalities Rare in Men With Metastatic Prostate Cancer Treated With Abiraterone Acetate

[TNCanuck]

Source: practiceupdate.com/content/...

TAKE-HOME MESSAGE

The authors report the management and outcomes of patients with elevated liver function test results secondary to abiraterone acetate therapy for metastatic prostate cancer. There were 46 liver disorder events seen in 25 men over 8 years at 3 French oncology centers. The median time from the start of treatment to the detection of liver toxicity was 7.1 weeks. In 52% of patients, liver function tests returned to baseline spontaneously while abiraterone was continued at full dose.

Liver events associated with abiraterone are rare and usually occur within the first 2 months of therapy. Most cases will resolve spontaneously.

BACKGROUND

Abiraterone acetate (abiraterone) combined with prednisone is a standard of care in metastatic castration-resistant prostate cancer. Recently, benefit in overall survival was reported in metastatic castration-sensitive prostate cancer also, and an extension of indication has been granted. Abiraterone is seldom associated with liver toxicity. The clinical management and the outcome of patients with transaminase increase while on abiraterone have not been described.

PATIENTS AND METHOD

We identified 25 men with metastatic prostate cancer and liver function test disorders occurring while on abiraterone treatment from December 2009 to September 2017 in three oncology centres in France.

RESULTS

Forty-six liver disorder events occurred in 25 patients while on abiraterone treatment. The median age at liver function test increase was 67 (55-85) years. The incidence of aspartate aminotransférase (AST) (24 events) and that of alanine aminotransférase (ALT) (22 events) increases were similar. Liver toxicity was of grade 1, 2 and 3 (Common Terminology Criteria for Adverse Events. version 4) in 7 (32%), 6 (27%) and 9 (41%) patients for ALT, and in 12 (50%), 6 (25%) and 6 (25%) for AST, respectively. The median time from abiraterone initiation to the detection of liver toxicity was 7.1 (4-95) weeks. The median time from highest ALT/AST increase to normalisation was 6.2 [2-14] weeks. In 13 patients (52%), liver tests spontaneously returned to baseline values, while abiraterone was continued at full dose.

CONCLUSION

Liver function test increase is a rare event that typically occurs within the first two months on abiraterone. Most patients experience normalisation of the tests, either spontaneously or after dose reduction/discontinuation.