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Zytiga (abiraterone acetate) as secondary hormone therapy - Dr Snuffy Myers thoughts


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Ketoconazole vs Zytiga before taxotere

Dr Snuffy Myers thoughts in a video posted on 3 August 2011

  • Ketoconazole has a clearly established role before taxotere - it has been studied ad nausium in this setting.
  • Small's publications, for instance, good evidence for this.
  • No anti-tumor superiority for Zytiga.
  • Convinced Ketoconazole a far safer drug than Zytiga.
  • Zytiga's main problem is that its clearance by the liver saturates within the clinical useable range. This means that a minor change in the amount of drug absorbed results in a big jump in blood level.
  • This is a problem because as Zytiga blood levels get higher, you get liver and heart damage.
  • How big a problem is this? When you take Zytiga with/without a meal, blood levels can go up 20 fold. And what is 'food'? Ketoconazole does not have this problem.
  • Both have problems with drug interactions with several common medications, including some statins (like Lipitor) and cough medicines. But Zytiga will jump much higher than Ketoconazole.
  • So, don't use Zytiga before taxotere until clinical trials have shown its safety in this setting.
  • On present indications (August 2011) Ketoconazole is a much safer drug than Zytiga.

This is a rapidly changing field, so this video may be outdated.

But check out the video yourself at:

Click for video

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