Practice Update: Oncology

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Managing mineralocorticoid
excess in mCRPC:
data review and clinical
recommendations
Interview with Neeraj Agarwal MD
Farzanna Haffizulla MD, FACP, FAWMA, who practices general internal medicine in Davie, Florida,
discusses Dr Agarwal’s work with eplerenone in managing mineralocorticoid excess in mCRPC.
Dr Haffizulla: Dr Agarwal, you have previously pub-
lished work related to eplerenone in managing
mineralocorticoid excess in patients with metastatic
castration-resistant prostate cancer after they receive
abiraterone. Can you tell us a little bit more about the
rationale for some of this work?
Dr Agarwal: Absolutely. Abiraterone, as we know, is
approved by FDA to be used along with prednisone.
That’s how most of the abiraterone trials were done.
However, many patients have concerns about long-
term use of prednisone, which is a corticosteroid, as
you know. Patients who have received prior immu-
notherapy drugs, they’re also very concerned about
using corticosteroids for a long time, so why we use
prednisone with abiraterone is because abiraterone
can cause increased mineralocorticoids, such as
aldosterone, causing fluid retention, low potassium,
hypertension, and so on.
So, how could we have avoided prednisone and still
block these side effects. The answer is use a drug
which can antagonize high aldosterone, which is
eplerenone. The advantage of eplerenone over more
traditional antagonists for aldosterone, such as spi-
ronolactone, is that it is a nonsteroidal antagonist, so
in theory it doesn’t stimulate prostate cancer cells. So,
I think that was the rationale behind using eplerenone
with abiraterone. And we saw that it was very safe, and
we were able to avoid prednisone in these patients.
I think it’s a very attractive option for our patients to
be able to use abiraterone without using prednisone.
Dr Haffizulla: That’s a wonderful option, absolutely. Well,
I want to thank you so much for sharing your expertise,
and perspective, and for bringing all of this vital infor-
mation to us at PracticeUpdate.
Dr Haffizulla practices general internal
medicine in Davie, Florida, within her own
internal medicine concierge practice.
Management of aggressive prostate cancer
variants
Ana Aparicio MD, Associate Professor
at the University of Texas MD Anderson
Cancer Centre, shares her management
strategies for aggressive prostate cancer.
Go to
to watch the full interview.
Dr Agarwal, a specialist in genitourinary cancer,
is Associate Professor of Medicine in the Division
of Oncology at the University of Utah School of
Medicine in Salt Lake City, where he is also the
Director of the Genitourinary Oncology Program.
Q & A 28
PRACTICEUPDATE ONCOLOGY