Survival of veterans treated with enzalutamide and abiraterone for metastatic castrate resistant prostate cancer based on comorbid diseases

Abstract

BackgroundComorbid diseases in uence patient outcomes, yet little is known about how comorbidities interact with treatments for metastatic castrate-resistant prostate cancer (mCRPC). No head-to-head trials have compared the e cacy of abiraterone and enzalutamide -oral androgen-receptor targeted agents (ARTAs) for mCRPC. In patients with comorbid disease, outcomes with ARTAs may differ due to disparate mechanisms of action, adverse events, and drug interactions. MethodsRetrospective observational study of US veterans starting treatment for mCRPC with abiraterone or enzalutamide between 9/2014 and 6/2017 to compare treatment duration and survival based on age and comorbid diseases. The association between treatment and overall survival (OS) was assessed using Cox proportional hazards and propensity-score matched modeling while adjusting for potential confounders. Sensitivity analyses were performed based on patient age, comorbidities, and subsequent treatments for mCRPC. ResultsOf 5822 veterans treated for mCRPC, 43.0% initially received enzalutamide and 57.0% abiraterone.Veterans initially treated with enzalutamide versus abiraterone were older (mean 75.8 vs. 75.0 years) with higher mean Charlson comorbidity index (4.4 vs. 4.1), and higher rates of cardiovascular disease or diabetes (74.2% vs. 70.6%). In the entire population, veterans initially treated with enzalutamide had longer median OS compared to those initially treated with abiraterone (24.2 vs. 22.1 months, p = 0.001).In veterans with cardiovascular disease or diabetes, median treatment duration with enzalutamide was longer (11.4 vs. 8.6 months, p < 0.001) with longer median OS compared to abiraterone (23.2 vs. 20.5 months, p < 0.001). In a propensity score matched cohort, enzalutamide was associated with decreased mortality compared to abiraterone (HR 0.90, 95% CI 0.84-0.96). ConclusionsVeterans with cardiovascular disease or diabetes had longer treatment duration and OS with enzalutamide compared to abiraterone. Further study of ARTA selection could bene t men with metastatic castrate resistant prostate cancer and likely hormone sensitive prostate cancer, especially among patients with comorbid diseases.

Real-life data of abiraterone acetate and enzalutamide treatment in post-chemotherapy metastatic castration-resistant prostate cancer in Poland

“…It shows that the OS was longer in patients treated with ENZA than ABI (24.2 vs 22.1 months) in pre- and post-chemotherapy treated patients. Importantly, patients with cardiovascular diseases also had better survival ( 9 ). Also, a direct comparison of drugs in 10,308 chemotherapy-naive patients with CRPC based on the 2014-2018 French population study showed that patients treated with ENZA had a better OS than ABI (34.2 vs. 31.7 mo.)…”

Adverse Events of Abiraterone Acetate vs Enzalutamide

“…We used the Medical Dictionary for Regulatory Activities (MedDRA, version 25.0) to treat each AE as a preferred term (PT) and grouped it into the System Organ Class (SOC). 16 We excluded several AEs to avoid false-positives when the total reported number in the PT level was <50. In total, we analyzed 285 AEs (Table 1).…”

Best of 2022 in prostate cancer and prostatic diseases

“…Schoen et al retrospectively evaluated survival of patients with mCRPC treated with enzalutamide (ENZA) or abiraterone (ABI) based on comorbidities [10]. Their study evaluated 5822 patients with 43% receiving ENZA and 57% receiving ABI.…”