Hospitalizations Among Veterans Treated for Metastatic Prostate Cancer With Abiraterone or Enzalutamide

Riekhof, F. Tempel; Yan, Yan; Bennett, Charles L.; Sanfilippo, Kristen M.; Carson, Kenneth R.; Chang, Su‐Hsin; Georgantopoulos, Peter; Luo, Suhong; Govindan, Srinivas; Cheranda, Nina; Afzal, Amber; Schoen, Martin W.

doi:10.1016/j.clgc.2023.07.006

Cited by 6 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another recent study, which compared the rate of hospitalization before and during treatment in mCRPC patients, identified a 22% increase in hospitalizations with AA compared to a 3% increase with Enz, despite being used in a younger population with less comorbid disease. Among the causes of hospitalization, AA was associated with a higher risk of infections: The analyses showed a 44% increase in urinary tract infections, a 114% increase in sepsis, and a 93% increase in pneumonia with AA compared to Enz when assessing the rate of infections during treatment relative to 1 year prior ( p < 0.0001) 25 . As typified by sepsis, glucocorticoids, co‐administered with AA, stand as another significant cause of these adverse events and are known contributors to sepsis.…”

Section: Discussionmentioning

confidence: 97%

“…Among the causes of hospitalization, AA was associated with a higher risk of infections: The analyses showed a 44% increase in urinary tract infections, a 114% increase in sepsis, and a 93% increase in pneumonia with AA compared to Enz when assessing the rate of infections during treatment relative to 1 year prior (p < 0.0001). 25 As typified by sepsis, glucocorticoids, co-administered with AA, stand as another significant cause of these adverse events and are known contributors to sepsis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Real‑world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration‐resistant prostate cancer

Tsujino,

Tokushige,

Komura

et al. 2023

Cancer Medicine

View full text Add to dashboard Cite

BackgroundThere is little evidence of abiraterone acetate (AA) plus prednisone for patients with non‐metastatic castration‐resistant prostate cancer (nmCRPC). In this study, we conducted a comparative analysis of real‐world survival outcomes between AA plus prednisone and enzalutamide (Enz) in patients with nmCRPC, utilizing our consortium dataset.Materials and MethodsThe clinical records of 133 nmCRPC patients treated with first‐line Enz or AA plus prednisone were analyzed. The primary endpoints of the study were overall survival (OS) and cancer‐specific survival (CSS). Cumulative incidence function (CIF) using Fine and Gray models was also utilized to assess non‐cancer‐caused death considering the competing risk of cancer‐caused death.ResultsDuring a median follow‐up of 36 months, 34 patients (25.6%) had deceased, with a median OS of 99 months in the entire cohort. There were no significant differences in comorbidities between the Enz and AA groups. Time to PSA progression (TTPP: HR 0.81, 95% CI 0.51–1.30, P = 0.375) and CSS (HR 1.32, 95% CI 0.55–3.44, P = 0.5141) were comparable between the two groups. However, intriguingly, there was a trend towards shorter OS in patients treated with AA plus prednisone compared to Enz (HR 0.57, 95% CI 0.29–1.12, P = 0.0978, median of 99 and 69 months in Enz and AA groups, respectively). CIF analysis revealed that nmCRPC patients treated with AA plus prednisone were more likely to result in non‐cancer‐caused death than those treated with Enz (HR 5.22, 95% CI 1.88–14.50, P = 0.0014).ConclusionsOur real‐world survival analysis suggests that while AA plus prednisone may demonstrate comparable treatment efficacy to Enz in the context of nmCRPC, there may be an increased risk of non‐cancer‐caused death. Physicians should take into consideration this information when making treatment decisions for patients with nmCRPC.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Real‑world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration‐resistant prostate cancer

Tsujino,

Tokushige,

Komura

et al. 2023

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…Also, patients with diabetes are at risk for infections, which are increased in patients taking abiraterone. 11 This increased rate of infections may be a result of the immune suppressive effects of prednisone or adrenal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Effect of BMI and hemoglobin A1c on survival of veterans with metastatic castration‐resistant prostate cancer treated with abiraterone or enzalutamide

Govindan,

Cheranda,

Riekhof

et al. 2023

The Prostate

View full text Add to dashboard Cite

BackgroundAbiraterone acetate and enzalutamide are two common therapies for metastatic castration‐resistant prostate cancer (mCRPC) that have shown improved overall survival (OS). The drugs have different mechanisms of action with limited comparative trials to evaluate treatment in patients with comorbidities such as obesity and diabetes. This is important since abiraterone requires the co‐administration of prednisone. We assessed the relationship between body mass index (BMI), hemoglobin A1c (HbA1c), treatment, and survival in mCRPC.MethodsVeterans treated with abiraterone or enzalutamide within the Veterans Health Administration between September 10, 2014 and June 2, 2017 with BMI and HbA1c were identified. Additional variables included age, baseline prostate‐specific antigen at first treatment for mCRPC, race, and the Charlson comorbidity index. Differences in survival were compared using the Kaplan–Meier method. Cox proportional hazards regression modeling was used to assess the association between initial treatment, BMI, and HbA1c while adjusting for confounding variables.ResultsA total of 5231 patients were identified with a mean age of 75.2 years and 1241 (23.7%) were of black race. BMI was associated with OS with longest median survival of 29.8 months in BMI ≥ 30 (n = 1903), 23.9 months in BMI 25–30 (n = 1879), 15.9 months in BMI 18.5–25 (n = 1336), and 9.2 months in BMI < 18.5 (n = 113, p < 0.001). In a multivariable model compared to normal BMI, increased mortality was observed in BMI < 18.5 (adjusted hazard ratio (aHR) = 1.583, 95% confidence interval [CI]: 1.29–1.94) and a decreased mortality in BMI 25–30 (aHR = 0.751, 95% CI: 0.69–0.81) and BMI > 30 (aHR = 0.644, 95% CI: 0.59–0.70). In 3761 patients with BMI > 25, there was longer OS in patients treated with enzalutamide (28.4 months, n = 1615) compared to abiraterone (25.8 months, n = 2146, p = 0.002). In 1470 patients with BMI < 25, there was no difference in OS between patients treated with enzalutamide (16.0 months, n = 597, p = 0.513) or abiraterone (16.1 months, n = 873). In 1333 veterans with HbA1c ≥ 6.5%, initial prescription of enzalutamide was associated with longer OS compared with abiraterone (24.4 vs. 20.5 months, p = 0.0005). In 2088 patients with HbA1c < 6.5%, there was no difference in OS in patients who were initially prescribed enzalutamide versus abiraterone (25.7 vs. 23.5 months, p = 0.334).ConclusionsIn veterans with mCRPC, increased BMI was associated with longer survival. Veterans with BMI > 25 had longer survival with enzalutamide compared to abiraterone. In patients with HbA1c ≥ 6.5%, enzalutamide was associated with longer survival compared to abiraterone. These results may facilitate prognostication of survival and improve treatment selection based on patient comorbidities.

show abstract

“…Sayan et al suggest that high-risk patients be considered for clinical trials, and many today would be given extended duration ADT as well as abiraterone or another androgen receptor pathway inhibitor. While these agents have proven efficacy, they are known to cause adverse events, especially in older patients with comorbid disease. Ideally, current-day risk stratification for early prostate cancer would include pathologic and genomic features of the prostate cancer combined with a detailed patient assessment of fitness and comorbid disease to truly understand the cancer itself and the patient to decide on the optimal intensity, type, and duration of treatment.…”

mentioning

confidence: 99%

Risk of Recurrence After Radiation in Early Prostate Cancer—Role of Risk Stratification From Prospective Trials

Schoen,

Bennett

2023

JAMA Netw Open

View full text Add to dashboard Cite

Hospitalizations Among Veterans Treated for Metastatic Prostate Cancer With Abiraterone or Enzalutamide

Cited by 6 publications

References 30 publications

Real‑world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration‐resistant prostate cancer

Real‑world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration‐resistant prostate cancer

Effect of BMI and hemoglobin A1c on survival of veterans with metastatic castration‐resistant prostate cancer treated with abiraterone or enzalutamide

Risk of Recurrence After Radiation in Early Prostate Cancer—Role of Risk Stratification From Prospective Trials

Contact Info

Product

Resources

About