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Management of anticoagulation in patients with metastatic castration–resistant prostate cancer receiving abiraterone + prednisone

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Abstract

Purpose

Abiraterone has been proven to be an effective agent used in the management of metastatic castration–resistant prostate cancer, significantly improving overall and progression-free survival. Due to the pharmacodynamic and pharmacokinetic properties of abiraterone, concurrent use with anticoagulation may pose a challenge for clinicians. Thrombosis within the cancer setting continues to increase patient mortality; therefore, appropriate anticoagulation through the use of a management algorithm can reduce adverse events and increase quality of life.

Methods

A review of the literature was preformed by a medical oncologist, haematologist and pharmacists to identify relevant randomized controlled trials, meta-analyses and retrospective studies. Major society guidelines were reviewed to further aid in developing the anticoagulation protocol for non-valvular atrial fibrillation and venous thromboembolism within this patient population. After reviewing the literature, a clinical framework was designed to aid clinicians in the management of those patients receiving abiraterone concurrently with an anticoagulant.

Results

In this review, we describe the potential interactions between abiraterone and various anticoagulants and provide management strategies based on the most recent literature for atrial fibrillation, venous thromboembolism and mechanical heart valves to avoid potential drug–drug interactions.

Conclusion

Abiraterone therapy has become a mainstay of the management of advanced prostate cancer and is often used over prolonged years. In this review, we have summarized a framework of how to use abiraterone in men with prostate cancer on anticoagulants. Evidence available to date suggests that patients with an indication for anticoagulation such as atrial fibrillation, venous thromboembolism and mechanical heart valves can be treated safely with abiraterone in the appropriate setting, with appropriate monitoring.

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Acknowledgements

I would like to extend sincere gratitude to Dr. Alia Thawer; she provided extensive support in addition to her expertise that greatly assisted this research. I would also like to show gratitude to Dr. Thomas McFarlane, Dr. Anne McLeod and Dr. Urban Emmenegger for sharing their pearls of wisdom and assistance in critical appraisal during the course of this research.

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Authors and Affiliations

  1. University of Waterloo School of Pharmacy, 10 Victoria St. S, Kitchener, ON, Canada

    Samuel Dubinsky & Thomas R.J. McFarlane

  2. Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Alia Thawer, Thomas R.J. McFarlane & Urban Emmenegger

  3. Department of Medicine, Division of Medical Oncology and Hematology, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada

    Anne G. McLeod

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  1. Samuel Dubinsky
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Correspondence to Samuel Dubinsky.

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The authors declare that they have no conflict of interest. Dr. Urban Emmenegger has received clinical research support (personal and institutional) from Janssen Inc., Canada, and has attended advisory board meetings.

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Dubinsky, S., Thawer, A., McLeod, A.G. et al. Management of anticoagulation in patients with metastatic castration–resistant prostate cancer receiving abiraterone + prednisone. Support Care Cancer 27, 3209–3217 (2019). https://doi.org/10.1007/s00520-019-04816-y

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