Prostate-specific antigen response in black and white patients treated with abiraterone acetate for metastatic castrate–resistant prostate cancer

Ramalingam, Sundhar; Humeniuk, Michael S.; Hu, Rachel; Rasmussen, Julia; Healy, Patrick; Wu, Yuan; Harrison, Michael R.; Armstrong, Andrew J.; George, Daniel J.; Zhang, Tian

doi:10.1016/j.urolonc.2016.12.016

Cited by 24 publications

(41 citation statements)

References 16 publications

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“…Separate analyses at several VA institutions also examined the rate of PSA decline in Black versus White patients treated with abiraterone or enzalutamide, another androgen receptor pathway–targeted inhibitor. These data were similar to the above trials and showed markedly higher rates of PSA reduction to levels of at least 50% of baseline and improved overall survival in Black men [96, 97].…”

Section: Attenuating Disparities Of Prostate Cancer Treatmentsupporting

confidence: 77%

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

et al. 2021

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Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exists among Black men in this country. This primary objective of this systematic review is to describe the reported disparities in screening, diagnostics and treatments as well as efforts to alleviate these disparities though community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, sub-analyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal access care environments have shown similar outcomes. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. The Oncologist 2021;9999:• • Implications for Practice: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher PSA, and other adverse factors, but outcomes can be attenuated in trials or in equal access care environments. Recent data has shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities. BACKGROUND Despite notable progress over the years, prostate cancer remains the leading cancer among men in the United States, with 191,000 cases and 33,000 deaths anticipated in 2020 1. Advances in screening rates, genomic testing, imaging, and treatment have led to an almost 98% five-year survival among affected men 2. Black men, however, have traditionally had higher incidence and decreased rates of survival in prostate cancer for all stages. Statistically, 1 in 9 men overall and 1 in 7 Black men will be affected 3. Moreover, Black men are more likely to be diagnosed at an earlier age, have advanced disease at that time of diagnosis and have significantly elevated PSA levels compared to White men 3-6. They also have a higher risk of regional and metastatic disease at presentation 7,8. Several factors could possibly account for this higher relative incidence and poorer outcomes for Black men with prostate cancer. Patients with lower socioeconomic status and less education have been shown to have worse overall survival from prostate and other ...

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Section: Attenuating Disparities Of Prostate Cancer Treatmentsupporting

confidence: 77%

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

et al. 2021

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“…A number of previous studies in Japanese patients with CRPC have also revealed a shorter PFS and OS compared with those in phase III trials ( 20 – 22 ). It has been reported that the differences in androgen receptor signaling between men of African and Caucasian descent accounts for the differences in the percentage of patients responding to AA, using the decline in PSA level as a marker of responsiveness, although there were no significant differences in PFS or OS ( 13 ). Similarly, it may be that the response in Japanese patients may also differ.…”

Section: Discussionmentioning

confidence: 99%

“…There is notable interest in confirming whether the efficacy of AA demonstrated in trial settings is reproducible in routine clinical practice, given the potential differences in the selection of patients, ethnic differences and other factors in day-to-day practice. AA is effective for DTX-naïve and post-DTX treated patients with CRPC, yet the efficacy of AA varies substantially between individuals ( 13 ). In addition, there is cross-resistance among DTX, AA and ENZ (a second-generation anti-androgen), and the sequence in which these drugs are administered to the patient affects the efficacy of treatment ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

Baseline prostate-specific antigen levels following treatment with abiraterone acetate as a prognostic factor in castration-resistant prostate cancer

Hiroshige¹,

Eguchi²,

Yoshizumi³

et al. 2018

Oncol Lett

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The aim of the present study was to investigate the prognostic factors associated with progression-free survival (PFS) and overall survival (OS) times in patients with castration-resistant prostate cancer (CRPC) who received treatment with abiraterone acetate (AA) in routine clinical settings. A total of 93 patients treated with AA between September 2014 and February 2017 were selected and their medical records were analyzed retrospectively. The median PFS time of docetaxel (DTX)-naïve patients was 171 days, and that of post-DTX patients was 56 days. The OS time of DTX-naïve patients did not reach the median. The median OS time of post-DTX patients was 761 days. Multivariate analyses identified baseline prostate-specific antigen (PSA) level prior to treatment with AA and the PSA response rate as independent prognostic factors for PFS time, and baseline PSA prior to treatment with AA as the only independent prognostic factor for OS time. The results of the present study indicate that the baseline PSA level prior to treatment with AA is a notable prognostic factor in patients with CRPC.

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“…There has been concern that use of ART drugs in clinical practice is continued too long and given that these drugs are expensive and are used by a large number of men with mCRPC, this could have large financial implications. A wide range in time on treatment for these drugs has been reported in previous observational studies, ranging from 3 to 20 months (S1 Table) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 89%

“…treatment for ART with a range from 3 up to more than 20 months, likely due to differences in study design, study population, and definition of drug stop [13][14][15][17][18][19][20][21][22][23][24][25].…”

Section: Plos Onementioning

confidence: 99%

Observational study on time on treatment with abiraterone and enzalutamide

et al. 2020

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Introduction The aim of this study was to assess time on treatment with abiraterone and enzalutamide, two androgen receptor targeted (ART) drugs, the impact on time on treatment of time interval without drug supply between prescription fillings, and adherence to treatment. Material and methods By use of data from The National Prostate Cancer Register, The Prescribed Drug Registry and the Patient Registry, time on treatment with the abiraterone and enzalutamide was analyzed in all men with castration resistant prostate cancer (CRPC) in Sweden 2015–2019. Three time intervals between consecutive fillings, i.e. time without drug supply, were assessed. Adherence to the treatment was evaluated by use of the Medication Possession Ratio. Kaplan Meier analysis and multivariable Cox regression model were used to assess factors affecting time on treatment. Results Between January 2015 and October 2019, 1803 men filled a prescription for abiraterone and 4 534 men filled a prescription for enzalutamide. With a time interval of 30 days or less between two fillings, median time on treatment was 4.9 months (IQR 2.6–11.7) for abiraterone and 8.0 months (IQR 3.6–16.4) for enzalutamide. In sensitivity analyses, allowing for no more than 14 days without drug supply between fillings, median time on treatment was 3.9 months (IQR 2.1–9.0) for abiraterone and 5.9 months (IQR 2.8–12.1) for enzalutamide. Allowing for any time period without drug between fillings, median time on treatment was 5.7 months (IQR 2.7–14.0) for abiraterone and 9.8 months (IQR 4.4–21.0) for enzalutamide. Adherence to treatment was above 90% for both drugs. Conclusion Time on treatment with abiraterone and enzalutamide was shorter in clinical practice than in randomized controlled trials and varied almost two-fold with time interval without drug. Adherence to treatment was high. The main limitation of our study was the lack of data on use of chemotherapy.

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Prostate-specific antigen response in black and white patients treated with abiraterone acetate for metastatic castrate–resistant prostate cancer

Cited by 24 publications

References 16 publications

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Baseline prostate-specific antigen levels following treatment with abiraterone acetate as a prognostic factor in castration-resistant prostate cancer

Observational study on time on treatment with abiraterone and enzalutamide

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