Treatment-Emergent Co-Morbidities and Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Abiraterone or Enzalutamide

Abstract

Secondary hormone therapy, abiraterone and enzalutamide, has improved outcomes for metastatic castration-resistant prostate cancer (mCRPC) and prolonged patients’ lives significantly. Various studies have compared the cancer-related outcomes, adverse effects, and drug-induced comorbidities in patients with mCRPC who are treated with abiraterone or enzalutamide. However, few studies have explored associations between survival and comorbidities or comprehensive analyzed newly developed comorbidities during and after secondary hormone therapy. We attempted to clarify whether the Charlson comorbidity index (CCI) overall or itemized is predictive for overall survival, and we compared newly developed comorbidities between abiraterone and enzalutamide groups. We extracted data about expenses and comorbidities for patients who have mCRPC, received abiraterone and enzalutamide and met pre-examination operation criteria between September 2016 and December 2017 from the Taiwan National Health Insurance database. A total of 1153 patients with mCRPC who received abiraterone (n = 782) or enzalutamide (n = 371) with or without previous chemotherapy were included. We used the propensity score to match confounding factors, including age, pre-existing comorbidities, and precipitating factors for comorbidity (e.g., hypertension, hyperlipidemia), to eliminate selection bias in the comparison of newly developed comorbidities. Cox regression analysis was used for overall survival. We found that enzalutamide is superior to abiraterone with regard to overall survival. Our study revealed that there is no statistically significant difference in development of new comorbidities between abiraterone and enzalutamide group. Moreover, the CCI score, rather than any single item of the CCI, was a statistically significant predictor for overall survival.

Treatment landscape and burden of disease in metastatic castration-resistant prostate cancer: systematic and structured literature reviews

“…Two studies (not identified in the current review) determined that patients treated with abiraterone reported less fatigue and cognitive impairment and had more favorable PROs compared with enzalutamide in both real-world and clinical trial settings ( 95 , 123 ). However, a propensity score-matching study found that whilst there was no significant difference in the development of new comorbidities between the two agents, OS was better with enzalutamide; moreover, the overall Charlson Comorbidity Index score (and not its items) was a significant predictor of OS ( 124 ). There is increasing awareness that HRQoL is an important endpoint of value to both patients and healthcare providers.…”

Comparative Effectiveness of Abiraterone and Enzalutamide in Patients With Metastatic Castration-Resistant Prostate Cancer in Taiwan

“…The OS rate in the current study showed no significant difference between the two groups, similar to the trends found in other Taiwan studies ( 13 , 22 ). However, a retrospective study conducted using the NHIRD showed that abiraterone (53.7%) had a significantly higher overall mortality rate than enzalutamide (40.55%) ( 23 ). Otherwise, the current study’s results on survival time were more similar to those observed in clinical trials and cohort studies from other countries.…”

Phase I clinical trial of HC‐1119 soft capsule in Chinese healthy adult male subjects: Pharmacokinetics and safety of single‐dose proportionality and effects of food

“… 6 Enzalutamide has improved outcomes for metastatic castration‐resistant prostate cancer (mCRPC) and prolonged patients' lives significantly. 7 According to highlights of prescribing of Food and Drug Administration, In four placebo‐controlled trials (AFFIRM, PROSPER, PREVAIL, and ARCHES), the most common adverse reactions (≥10%) that occurred more frequently (≥2% over placebo) in the XTANDI‐treated patients were asthenia/fatigue, back pain, hot flush, constipation, arthralgia, decreased appetite, diarrhea, and hypertension. Adverse reactions of enzalutamide including seizure, posterior reversible encephalopathy syndrome (PRES), hypersensitivity, ischemic heart disease, falls and fractures are warned and required precaution.…”