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

Abstract

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.

Cardiovascular events among patients with prostate cancer treated with abiraterone and enzalutamide

“…Additionally, a comprehensive systematic review of realworld studies found few literature reviews on cardiovascular events [10]. Shah et al found more pronounced cardiovascular events in patients using AA than ENZ therapy [10]; however, some of the articles identified included research populations with pre-existing cardiovascular conditions [10].…”

“…Additionally, a comprehensive systematic review of realworld studies found few literature reviews on cardiovascular events [10]. Shah et al found more pronounced cardiovascular events in patients using AA than ENZ therapy [10]; however, some of the articles identified included research populations with pre-existing cardiovascular conditions [10]. By contrast, we excluded patients with pre-existing CVD to distinguish new cases of CVD from ongoing episodes and to make a stronger correlation that the identified cardiovascular events were due to the adverse effects of the medication.…”

“…63, 137-146 https://doi.org/10.2340/1651-226X.2024.20337 patients with CRPC and, more recently, of patients with metastatic hormone-sensitive disease naive to hormonal agents [8,9]. However, adverse drug effects are common with these hormonal therapies and may vary with patient and drug characteristics [10,11]. Furthermore, cardiovascular disease (CVD) is a primary cause of noncancer mortality in men with prostate cancer [12].…”

“…Real-world studies showing the association between cardiovascular events related to hormonal treatments and preexisting metabolic, cardiovascular, or neurological conditions are limited [7,10,[15][16][17]. Furthermore, because differential adverse effects of AA and ENZ and their interactions with patient comorbidities have not been fully elucidated, there is little guidance on how to choose these drugs based on pre-existing conditions [10]. cardiovascular comorbidities prior to the index date.…”

Risk assessment of organ transplant operation: A fuzzy hybrid MCDM approach based on fuzzy FMEA

“…Studies have shown that continued use of these drugs after transplantation increases the risk of cardiovascular disease and cancer, further decreasing transplant survival and death [ 9 ]. Cancer is the most prevalent complication in transplant recipients compared to other patients, which is associated with higher mortality rates and a reduced post-transplant survival rate [ 10 , 11 ].…”