Outcomes Among African American and Non-Hispanic White Men With Metastatic Castration-Resistant Prostate Cancer With First-Line Abiraterone

Marar, Mallika; Long, Qi; Mamtani, Ronac; Narayan, Vivek; Vapiwala, Neha; Parikh, Ravi B.

doi:10.1001/jamanetworkopen.2021.42093

Cited by 19 publications

(31 citation statements)

References 20 publications

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“…Interestingly, two studies reported differences in AA outcomes based on race and ethnicity, finding that African American men experienced improved PSA response and OS compared with non-Hispanic White men [ 54 , 55 ]. These findings warrant further analyses of the differential impacts of race and ethnicity on AA versus ENZ outcomes to determine the utility of these patient-specific traits in treatment assignment algorithms.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Abiraterone versus Enzalutamide for Prostate Cancer: A Scoping Review

Shah

Shaver

Beiriger

et al. 2022

Cancers

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Abiraterone acetate (AA) and enzalutamide (ENZ) are commonly used for metastatic prostate cancer. It is unclear how their outcomes and toxicities vary with patient-specific factors because clinical trials typically exclude patients with significant comorbidities. This study aims to fill this knowledge gap and facilitate informed treatment decision making. A registered protocol utilizing PRISMA scoping review methodology was utilized to identify real-world studies. Of 433 non-duplicated publications, 23 were selected by three independent reviewers. ENZ offered a faster and more frequent biochemical response (30–50% vs. 70–75%), slowed progression (HR 0.66; 95% CI 0.50–0.88), and improved overall survival versus AA. ENZ was associated with more fatigue and neurological adverse effects. Conversely, AA increased risk of cardiovascular- (HR 1.82; 95% CI 1.09–3.05) and heart failure-related (HR 2.88; 95% CI 1.09–7.63) hospitalizations. Ultimately, AA was associated with increased length of hospital stay, emergency department visits, and hospitalizations (HR 1.26; 95% CI 1.04–1.53). Accordingly, total costs were higher for AA, although pharmacy costs alone were higher for ENZ. Existing data suggest that AA and ENZ have important differences in outcomes including toxicities, response, disease progression, and survival. Additionally, adherence, healthcare utilization, and costs differ. Further investigation is warranted to inform treatment decisions which optimize patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes Following Abiraterone versus Enzalutamide for Prostate Cancer: A Scoping Review

Shah

Shaver

Beiriger

et al. 2022

Cancers

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“…cPFS as a composite endpoint has been used previously as one of the endpoints to assess the efficacy of enzalutamide in patients with metastatic PC [28] Another study, which had a median follow-up of 19 months, showed that Black men with mCRPC had a significantly lower risk of death than White men, with a 33% risk reduction when treated with NHTs (either abiraterone or enzalutamide as first-line therapy) [26]. Conversely, a recent study using the community oncology EHR Flatiron Health database with a short median follow-up duration (13 months) showed that although treatment with both NHTs was associated with a similar median OS in White men and Black men (24 months), enzalutamide may have a marked superiority over abiraterone in increasing OS in White men (median OS: 20 months [enzalutamide] vs. 17 months [abiraterone]; HR of death 1.21; 95% CI 1.06-1.38) [27]. The difference in outcomes observed in the latter two studies may be attributable to the inherent strengths and limitations of the study designs and the analyzed data source [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, a recent study using the community oncology EHR Flatiron Health database with a short median follow-up duration (13 months) showed that although treatment with both NHTs was associated with a similar median OS in White men and Black men (24 months), enzalutamide may have a marked superiority over abiraterone in increasing OS in White men (median OS: 20 months [enzalutamide] vs. 17 months [abiraterone]; HR of death 1.21; 95% CI 1.06-1.38) [27]. The difference in outcomes observed in the latter two studies may be attributable to the inherent strengths and limitations of the study designs and the analyzed data source [26,27]. Further, the 12month landmark cPFS analysis was performed in this study to assess early trends in treatment outcome and to address the challenge of non-availability of data for the entire follow-up period due to movement of patients to an oncology setting.…”

Section: Discussionmentioning

confidence: 99%

Prostate-specific antigen response and clinical progression-free survival in Black and White men with chemotherapy-naïve metastatic castration-resistant prostate cancer treated with enzalutamide in a real-world setting

Freedland

Hong

El-Chaar

et al. 2022

Prostate Cancer Prostatic Dis

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Background In the United States, Black men have a higher incidence of prostate cancer (PC)-related mortality than men of other races. Several real-world studies in advanced PC suggest, however, that Black men respond better to novel hormonal therapies than White men. Data on treatment responses to enzalutamide by race are limited. We assessed real-world prostate-specific antigen (PSA) response and clinical progression-free survival (cPFS) of Black vs. White men with chemotherapy-naïve PC treated with enzalutamide. Methods This retrospective cohort study included patients with PC who initiated enzalutamide treatment from 2014 to 2018 in the IntrinsiQ Specialty Solutions™ database, a collection of electronic medical records from community urology practices. Index date was the date of the first prescription for enzalutamide, used as a proxy for metastatic castration-resistant PC (mCRPC). Patients who had undergone chemotherapy and/or abiraterone therapy were excluded. Kaplan–Meier and Cox models adjusted for baseline characteristics were used to estimate PSA response and cPFS by race. Results The study included 214 Black and 1332 White men with chemotherapy-naïve PC presumed to have mCRPC based on the enzalutamide indication during the study period. Black men were younger and had higher baseline median PSA levels than White men. Enzalutamide therapy duration, follow-up time, and number of post-index PSA tests were similar between races. In multivariable analyses, the risk of patients achieving a ≥ 50% PSA decline was similar, whereas a numerically higher trend of ≥90% PSA decline was observed in Black men (HR 1.23; 95% CI 0.93–1.62 [P = 0.14]). In the multivariable analysis, Black men had significantly better cPFS (HR 0.82; 95% CI 0.68–0.98 [P = 0.03]). Conclusions Black and White men with presumed chemotherapy-naïve mCRPC had similar PSA responses when treated with enzalutamide, but Black men had better cPFS than White men. Further research is warranted to validate these findings.

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“…Recent reports from VanDAAM (NCT0272373), a multisite validation study of the genomic classifier Decipher in AA men, highlights impact and importance of investing in and including clinical trials focused on minority populations, to reduce disparities in clinical outcomes. 26 Indeed, reports emerging from a retrospective cohort study demonstrated that AA patients with advanced prostate cancer who received first-line abiraterone had significantly longer median survival compared with non-Hispanic White patients (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) vs. 17 months [IQR: 9−32 months]). 27 A phase III trial showed that AA patients receiving sipuleucel-T had improved overall survival (OS) (30.7 vs. 3.9 months), albeit AA patients made up only 6% of all patients in the study.…”

Section: Bridging the Gap Between Biologic Individual And Macroenviro...mentioning

confidence: 99%

“…26 Indeed, reports emerging from a retrospective cohort study demonstrated that AA patients with advanced prostate cancer who received first-line abiraterone had significantly longer median survival compared with non-Hispanic White patients (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) vs. 17 months [IQR: 9−32 months]). 27 A phase III trial showed that AA patients receiving sipuleucel-T had improved overall survival (OS) (30.7 vs. 3.9 months), albeit AA patients made up only 6% of all patients in the study. 28 Trust between patients and doctors allows better communication on both sides and better compliance with healthcare recommendations.…”

Section: Bridging the Gap Between Biologic Individual And Macroenviro...mentioning

confidence: 99%

Exploring new frontiers in prostate cancer research: Report from the 2022 Coffey−Holden prostate cancer academy meeting

et al. 2022

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Introduction The 2022 Coffey−Holden Prostate Cancer Academy (CHPCA) Meeting, “Exploring New Frontiers in Prostate Cancer Research,” was held from June 23 to 26, 2022, at the University of California, Los Angeles, Luskin Conference Center, in Los Angeles, CA. Methods The CHPCA Meeting is an annual discussion‐oriented scientific conference organized by the Prostate Cancer Foundation, that focuses on emerging and next‐step topics deemed critical for making the next major advances in prostate cancer research and clinical care. The 2022 CHPCA Meeting included 35 talks over 10 sessions and was attended by 73 academic investigators. Results Major topic areas discussed at the meeting included: prostate cancer diversity and disparities, the impact of social determinants on research and patient outcomes, leveraging real‐world and retrospective data, development of artificial intelligence biomarkers, androgen receptor (AR) signaling biology and new strategies for targeting AR, features of homologous recombination deficient prostate cancer, and future directions in immunotherapy and nuclear theranostics. Discussion This article summarizes the scientific presentations from the 2022 CHPCA Meeting, with the goal that dissemination of this knowledge will contribute to furthering global prostate cancer research efforts.

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Outcomes Among African American and Non-Hispanic White Men With Metastatic Castration-Resistant Prostate Cancer With First-Line Abiraterone

Cited by 19 publications

References 20 publications

Outcomes Following Abiraterone versus Enzalutamide for Prostate Cancer: A Scoping Review

Outcomes Following Abiraterone versus Enzalutamide for Prostate Cancer: A Scoping Review

Prostate-specific antigen response and clinical progression-free survival in Black and White men with chemotherapy-naïve metastatic castration-resistant prostate cancer treated with enzalutamide in a real-world setting

Exploring new frontiers in prostate cancer research: Report from the 2022 Coffey−Holden prostate cancer academy meeting

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