Real-world outcomes of abiraterone and enzalutamide in first-line treatment of metastatic castration-resistant prostate cancer: which patients benefit most?

• Published in: European journal of hospital pharmacy. Science and practice Vol. 30; no. 5; pp. 268 - 272
• Main Authors: García Trevijano Cabetas, Macarena, Escario-Gómez, Miguel, González-Del Valle, Luis, Sobrino Jiménez, Carmen, Bilbao Gomez-Martino, Cristina, Romero-Garrido, José Antonio, Benedi-González, Juana, Espinosa Arranz, Enrique, Díaz Almirón, Mariana, Herrero Ambrosio, Alicia
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.09.2023; BMJ Publishing Group
• Subjects: Androgens; Antigens; Cancer therapies; Chemotherapy; Hemoglobin; Lymphatic system; Medical prognosis; Metastasis; Narcotics; Oncology; Open source software; Original Research; Patients; Pharmacy; Phosphatase; Prostate cancer
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2021-002798

ObjectivesAbiraterone and enzalutamide are two oral novel androgen receptor axis-targeted agents approved for the treatment of castration-resistant prostate cancer (mCRPC). Despite the availability of multiple treatments, there is a need to improve the knowledge and management of these drugs in the real-world setting, especially in patient groups under-represented in clinical trials. Our aim was to review the outcome of patients with chemotherapy-naïve mCRPC treated with abiraterone or enzalutamide in routine clinical practice in order to identify factors that are predictive for response.MethodsThis observational retrospective study was performed in a Spanish tertiary hospital and included men with chemotherapy-naïve mCPRC who started treatment with abiraterone or enzalutamide between September 2012 and November 2018. The study end date was 30 October 2020.ResultsNinety patients with mCRPC were included, 57 with abiraterone and 33 with enzalutamide. Median overall survival (OS) was 26.87 months (95% CI 19.68 to 34.05), with no difference found between the two treatment groups. Nine variables were related to increased OS in the univariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (0–1 vs 2), pain (need of opioids for cancer pain), visceral disease, ≥3 bone lesions, exclusively lymph node metastases, baseline prostate specific antigen (PSA) (<50 vs ≥50 ng/dL and <20 vs ≥20 ng/dL), haemoglobin (<12 vs ≥12 g/dL) and alkaline phosphatase (≤116 vs >116 IU/L). A PSA response >50% was observed in 65 patients (76.5%). In the multivariate analysis, ECOG performance status, pain, visceral disease and alkaline phosphatase provided independent prognostic information. Median OS by Kaplan–Meier analysis was significantly longer for patients with a PSA response (32.1 vs 17.9 months; HR 0.46, 95% CI 0.27 to 0.78; p=0.003).ConclusionsThis study assessed the efficacy of abiraterone and enzalutamide in a real-world setting, including patients under-represented in pivotal studies. Some clinical factors were correlated with improved OS in chemotherapy-naïve men with mCPRC treated with these drugs.