Talk:Abiraterone acetate

Chemical structure

No structure is shown for this article. It is here: http://www.chemspider.com/Search.aspx?q=Abiraterone--ChemSpiderMan (talk) 00:18, 25 January 2008 (UTC)

Added. -- Ed (Edgar181) 15:49, 25 January 2008 (UTC)

Edgar...please check the name. I think it is: (3S,8R,9S,10R,13S,14S)-10,13-Dimethyl-17-(3-pyridinyl)-2,3,4,7,8,9,10,11,12,13,14,15-dodecahydro-1H-cyclopenta[a]phenanthren-3-ol--ChemSpiderMan (talk) 16:05, 25 January 2008 (UTC)

I just copied the one at the PubChem link. I don't know how to judge which is more appropriate, so feel free to use whichever you feel is best. -- Ed (Edgar181) 16:08, 25 January 2008 (UTC)

NHS Availability

"In the UK, despite being licensed by the European Medicines Agency,[15] the drug is not currently[when?] available for routine use on the NHS. In February 2012, the National Institute for Health and Clinical Excellence (NICE) issued[16] preliminary guidance that the drug will not be made available on cost-effectiveness grounds, but this decision is open to consultation.[17] The decision was reversed in May 2012.[18][19][20][21][22][23][24]"

This sentence needs cleaning up. http://scienceblog.cancerresearchuk.org/2012/05/16/abiraterone-now-available-on-the-nhs-except-in-scotland/ — Preceding unsigned comment added by 87.237.64.150 (talk) 10:47, 28 May 2014 (UTC)

I have updated this to read more clearly and with latest guidance. I made the decision to remove all the references to media articles, but wouldn't object if someone felt they needed to be reinserted. Lukeshounsome (talk) 11:59, 6 March 2015 (UTC) LukeSHounsome

Source

For the “Adverse Effects” section, there is an opportunity to increase the accuracy and completeness of the information available on adverse reactions by referring to the following source: ZYTIGA® (abiraterone acetate) [package insert]. Horsham, PA: Janssen Biotech, Inc. http://www.zytigahcp.com/full-prescribing-information. For the "Interactions" section, there is an opportunity to increase the accuracy and completeness of the information available on interactions by referring to the following source: ZYTIGA® (abiraterone acetate) [package insert]. Horsham, PA: Janssen Biotech, Inc. http://www.zytigahcp.com/full-prescribing-information. {{Lflaiz (talk) 14:46, 13 August 2014 (UTC)|Janssen Biotech, Inc. }}

Unreported early phase trial

Pointing to an early phase clinical trial that has closed to accrual but which has not reported is ill-advised. There may be exceptions to this, so if there is a specific reason this particular phase 1 trial should be exempt from this precautionary standard please discuss in detail here before adding back. FeatherPluma (talk) 22:56, 19 November 2015 (UTC)

You're referring to the trial in breast cancer? I think its notable that the trial is being performed, as it points out that androgen antagonism is of current (as of 2015) interest in breast cancer research. No one is making any medical claims, only pointing out that the trial is being performed, which is a readily verified fact. Nor is anyone predicting the outcome of the trial. Our bios of presidential candidates mention that they are running for the office, no one says that it is WP:CRYSTALBALL to do so as long as one does not attempt to predict who the winner will be.

Notability is established because the trial is referred to in several breast cancer review articles (secondary sources). Directly here. Indirectly here.

For comparison, we had a full article on ibrutinib in 2011 when it was still in Phase 2. Ditto sofosbuvir. This is just a paragraph in an article that is mainly focused on the drug's approved use.

(((From the page history, the above unsigned / undated response is marked as 2015-11-20T00:32:23‎ by169.230.155.123. This addition to the response added as a courtesy by FeatherPluma (talk) 03:42, 12 December 2015 (UTC) )))

Respectfully, I disagree. I saw your prompt response. I decided to mull this over for a few days to see if I could come around to the notion that this content might somehow be appropriate. But I find that it is doubly flawed. FIRST, it is unhelpfully off topic. This is not an article about breast cancer, or about AR antagonism in breast cancer. It's an article about abiraterone acetate (AA). And at the present time, abiraterone is not a serious candidate for use in breast cancer, even if it has been mentioned as one of the hundreds of drugs that are being tested in breast cancer. If the article were about AR antagonists in BC, which is an interesting topic as of 2015, we would discuss the preliminary but at least published (positive benefit?) data for enzalutamide, we would discuss what was published with bicalutamide (mildly positive benefit?), and we would discuss the general history and context, maybe e.g. halotestin etc. We would use published info, albeit preliminary, rather than abstractly speculative, just like was used for ibrutinib in 2011. Ditto sofosbuvir. Different from this trial. And if we were discussing publically available data for abiraterone in breast cancer, we would point to its recent seeming failure (negative for benefit). And then we could get into the technicalities of whether it was a truly AR enriched population, as this is a bit unclear, there being a mild discrepancy between 2 places within the text on that detail. And we could get into the article discussion, which includes multiple interesting thoughts about AA in BC. Such as 1: "At present, it has not been demonstrated that AR signaling drives de novo or acquired resistance to endocrine therapy [6], although some preclinical studies suggest that this is true [5, 10]." 2: "The AA-induced increases in serum progesterone concentrations observed in all patients may have attenuated any antitumor activity due to androgen biosynthesis inhibition in this study. AA-mediated inhibition of androgen biosynthesis may lead to a subsequent diversion into the progesterone synthetic pathway via adrenal dehydroepiandrosterone and pregnenolone [11]. AA-induced elevated progesterone concentrations could then provide a growth stimulus through the PR or through other mechanisms [12–14]." (Conceptually note that this problem would not be likely with other AR pathway blockers like enzalutamide that work at a different location in the cascade). 3: "Enrollment to the AA arm was discontinued after 89 patients enrolled, as the data review committee determined that the prespecified futility conditions had been met." (Just to be clear, this means AA "crapped out".) And most convincingly 4: "a phase III trial will not be pursued." ALL of which kinda sucks for AA in BC as of 2015? Let's be totally clear here - how appropriate do you really think it is to give any weight in this article to this one particular unpublished CRUK clinical trial, given that the potentially USEFUL page I cited (rather than the deadlink you chose to add back) reveals that the trial took something like 6 years to accrue an unknown number of participants (or is it 74, as the Cougar sponsored article / references suggest?) to an early phase dose escalation "exploratory" trial (that will almost certainly have no clinical bearing on the field even if it suggests some type of response - how could it???), which has apparently not produced a glimmer of data for public analysis (or has it?), and which has been closed to accrual for uuummmmmm 18 months i.e. quite a while comparatively for a phase I/II or whatever it is /was? Oh, and the potentially useful web page mark up indicates that it hasn't been reviewed or updated since 30 June 2014. Fan bloody tastic. We do have a WP:MEDRS policy, and this isn't sitting close to that. How long will we have to wait for any idea about this trial? As you know, there may NEVER be a report. SECOND, this content is not information (i.e. something that informs). It's trivia. It's tone and "substance" is completely adrift in the other elements of this abiraterone article, which you admit is "an article that is mainly focused on the drug's approved use". Either you misunderstand the technical use of criteria for WP:N, if that's your intended use of "notable", or alternatively you severely misconstrue the common language use of the term "notable". You have ONE reasonable (sort of) reference from 2014, from people who may well be affiliated with the trial (it would appear geographically), but who seem to be basic science Endocrine Lab people, and who MENTION abiraterone in isolated sentences three times, indicating that abiraterone is in trial. So what? The fact is that this trial is in process, but is insubstantial, is unreported, and isn't notable in common parlance. It just gets worse. Your pmid=21171672 from 2010 references 2 in-house pharma company citations (article's refs 18 and 19, from 2008 and 2009) as its basis. Hummmmpfff. No. Pharma references from 2008 and 2009 do not cut the mustard. Not happening. Moving on. Your pmid 21948654 mentions a few BC patients who seemingly had some durability with AA. Smells good, at least we have something. But that's the best signal I could discern. But, oopsy, the thrust of the article is actually about EOC (you oopsy "didn't remember" to expand that particular reference, unlike your others), and, moreover, seemingly the data in BC was for a few people and I think the language used makes it sound as if it was very preliminary information. Given the complexities of this situation as discussed it's irresponsible to hang on to this particular unpublished trial as if it were in some way highly relevant. And then there is the "indirect" pmid 22222232. Yup, it does mention breast cancer and it does mention abiraterone, but never in the same paragraph. "Indirect" indeed, to the degree that we use the label "WP:OR". This is not looking by analogy like some properly announced candidate in presumably some US (?) election. Let's redraw your analogy based on the evidence: it's looking very much like one of these long-stalled runs for sainthood, sponsored by some underpopulated, obscure, tiny hamlet somewhere in some far, far away perpetual cloud, up in the mountains of Outermost Dreamland. Even worse, the saint seems to have left some awfully naughty marks on the linen. Now, granted, it isn't IMPOSSIBLE that a future subset analysis will show that a particular BC biology benefits from AA. And it isn't impossible that somebody else from the hamlet in the clouds will be able to explain away the sins in a manner resembling Iressa in the general population, and so rehabilitate AA in BC in a specific way. Some ideas of how this might happen hypothetically have been discussed. I am sorry but at present I cannot get enthusiastic about this content. I am removing it, after a lot of thought. Feel free to provide a rigorous counterargument. FeatherPluma (talk) 02:02, 12 December 2015 (UTC)

References

Chemical structure

The cited Medscape article (after one clicks tot he Interactions page) does not support the claim that ketoconazole and other CYP17 inhibitors should be avoided. The rationale for that claim also makes little sense. Both abiraterone and those agents are inhibitors. Abiraterone isn't a substrate. — Preceding unsigned comment added by 73.223.123.144 (talk) 22:38, 21 September 2017 (UTC)

Merger proposal

I propose that this Abiraterone acetate be merged with Abiraterone. The majority of the latter consists of explanation of the active metabolite. According wikipedia notability guidelines, it makes the most sense to have a single article on the therapeutic agent, with appropriate redirect and short article content on the prodrug. Admittedly, I have limited experience with editing pharmacology pages, so I welcome justifications for keeping these pages separate. Dr G (talk) 20:26, 13 January 2018 (UTC)

Thanks for your note. The prodrug is what is administered as the drug. Abiraterone acetate is also the International nonproprietary name (INN), and per WP:PHARMMOS, the article title should be the INN. Therefore if there is any merger, it should be in the other direction. However I believe that they should be kept separate (different compounds, different articles). Abiraterone acetate should be main article whereas abiraterone should concentrate on the chemical and in vitro properties of the active metabolite. Boghog (talk) 21:52, 13 January 2018 (UTC)

Thanks for your response. This helps me better understand dealing with pharma articles. I will retract my proposal. Dr G (talk) 21:00, 14 January 2018 (UTC)

Lower cheaper dose may be possible with some food

Low-fat meal enhances efficacy of reduced-dose abiraterone for prostate cancer seems hugely significant for this drug. May need to look for a few more sources and discussion on this to see if this report is a fair summary. - How will medics, insurers, FDA, EU etc react ? - Rod57 (talk) 10:43, 11 April 2018 (UTC)

yes, in connection with the above comment, take on an empty stomach for the 1000mg dosage

The text says take with food. I am sure this is incorrect, but I only added /citation needed/. My bad. ( Martin | talk • contribs 05:45, 3 December 2018 (UTC))

Ok, the reference actually says take on an empty stomach. So I will change the text. ( Martin | talk • contribs 05:48, 3 December 2018 (UTC))

INN

I have moved this article to the INN which is "abiraterone". Having separate articles for "abiraterone" and "abiraterone acetate" does not make sense. We have hundreds of medications like atorvastatin calcium which should go to atorvastatin to prevent confusing our readers. The various salts can generally be disused in one spot. Doc James (talk · contribs · email) 11:59, 15 November 2019 (UTC)