IMR Press / JOMH / Volume 17 / Issue 4 / DOI: 10.31083/jomh.2021.041
Open Access Original Research
Enzalutamide versus Abiraterone Acetate as first-line treatment of castration resistant metastatic prostate cancer in geriatric (75) patients
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1 Muğla Sıtkı Koçman University School of Medicine, Medical Oncology, 48000 Muğla, Turkey
2 Dokuz Eylül University School of Medicine, Medical Oncology, 35220 İzmir, Turkey
3 Ankara University School of Medicine, Medical Oncology, 06560 Ankara Turkey
4 Dr. Abdurrahman Yurtarslan Research and Training Hospital, Medical Oncology, 06200 Ankara, Turkey
5 Pamukkale University School of Medicine, Medical Oncology, 20160 Denizli, Turkey
6 Marmara University School of Medicine, Medical Oncology, 34722 İstanbul, Turkey
7 Selçuk University School of Medicine, Medical Oncology, 42250 Konya, Turkey
8 Bahçeşehir University School of Medicine, İstanbul and Medical Park İzmir Hospital, Medical Oncology, 34488 İzmir, Turkey
9 Atatürk Chest Disease and Chest Surgery Research and Training Hospital, Department of Medical Oncology, 06280 Ankara, Turkey
10 Akdeniz University School of Medicine, Medical Oncology, 07070 Antalya, Turkey
11 Afyon Kocatepe University School of Medicine, Medical Oncology, 03200 Afyon, Turkey
12 Trakya University School of Medicine, Medical Oncology, 22030 Edirne, Turkey
13 Gülhane Research and Training Hospital, Medical Oncology, 06010 Ankara, Turkey
14 Erciyes University School of Medicine, Medical Oncology, 38280 Kayseri, Turkey
15 Kütahya Health Science University, Evliya Çelebi Research and Training Hospital, Medical Oncology, 43100 Kütahya, Turkey
16 Muğla Sıtkı Koçman University School of Medicine, Radiation Oncology, 48000 Muğla, Turkey
17 Muğla Sıtkı Koçman University School of Medicine, Internal Medicine, 48000 Muğla, Turkey
18 Yıldırım Beyazıt University, Atatürk Research and Training Hospital, Medical Oncology, 06760 Ankara, Turkey
J. Mens. Health 2021, 17(4), 128–134; https://doi.org/10.31083/jomh.2021.041
Submitted: 18 January 2021 | Accepted: 2 March 2021 | Published: 30 September 2021
(This article belongs to the Special Issue Therapy and prognosis of metastatic prostate cancer)
Abstract

Introduction: The efficacy and tolerability of Enzalutamide and Abiraterone Acetate have been reported in elderly patients with metastatic castration resistant prostate cancer (mCRPC). However, there is no randomized study directly comparing antitumor effects between these 2 agents in geriatric patients. We aimed to evaluate the efficacy of Enzalutamide (ENZA) and Abiraterone Acetate (AA) as a first-line treatment of mCRPC in elderly patients.

Materials and methods: The geriatric patients (75 years of age) with a diagnosis of mCRPC and treated with first-line ENZA or AA were included. The impacts of clinical parameters and treatment modalities on overall survival (mOS) were analyzed retrospectively and Cox regression analysis was performed.

Results: One hundred thirty-four mCRPC patients (77 in AA, 57 in ENZA), with a median age of 81 (75–93) were analyzed. The patient and disease characteristics were similar between arms. While there were more grade 1–2 toxicities in AA arm (45.5% vs 17.5%, P = 0.001), the discontinuation due to toxicity was similar between groups (8.5% vs 5.9%, P = 0.81). The mOS was 18.0 months (95% CI, 15.2–20.7) in AA, and 20.0 months (95% CI, 4.4–35.5) in ENZA arm (P = 0.47). In multivariate analysis, high Gleason score (8) (HR: 2.0 (95% CI, 1.1–3.4), P = 0.009) and high initial PSA values (100 ng/mL) (HR: 2.6 (95% CI, 1.5–4.8), P = 0.001) were poor prognostic factors. The choice of AA vs ENZA was insignificant as a predictor of OS (HR: 0.87 (95% CI, 0.48–1.56), P = 0.65).

Conclusion: In the first-line treatment of mCRPC in elderly (75) patients, AA and ENZA showed similar results in terms of mPFS and mOS. The clinical impacts of second-generation androgen receptor pathway inhibitors in the elderly population should be tested in prospective randomized studies.

Keywords
Metastatic castration-resistant prostate cancer
Enzalutamide
Abiraterone Acetate
Elderly
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