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

Autor:	García Trevijano Cabetas M; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain macarena.garciatrevijano@salud.madrid.org., Escario-Gómez M; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain., González-Del Valle L; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain., Sobrino Jiménez C; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain., Bilbao Gomez-Martino C; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain., Romero-Garrido JA; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain., Benedi-González J; Pharmacy Department, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain., Espinosa Arranz E; Medical Oncology Department, La Paz University Hospital, Madrid, Spain., Díaz Almirón M; Hospital Statistics Department, La Paz University Hospital, Madrid, Spain., Herrero Ambrosio A; Hospital Pharmacy Department, La Paz University Hospital, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	European journal of hospital pharmacy : science and practice [Eur J Hosp Pharm] 2023 Sep; Vol. 30 (5), pp. 268-272. Date of Electronic Publication: 2021 Oct 07.
DOI:	10.1136/ejhpharm-2021-002798
Abstrakt:	Objectives: Abiraterone 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. Methods: This 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. Results: Ninety 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). Conclusions: This 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. Competing Interests: Competing interests: None declared. (© European Association of Hospital Pharmacists 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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