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Open Access Special Issue

Enzalutamide versus Abiraterone Acetate as first-line treatment of castration resistant metastatic prostate cancer in geriatric (≥75) patients

  • Ali Alkan1
  • Zeynep Gülsüm Güç2
  • Mustafa Gürbüz3
  • Güliz Özgün4
  • Serkan Değirmencioğlu5
  • Mutlu Doğan4
  • Tuğba Akın Telli6
  • Özge Keskin7
  • Çağatay Arslan8
  • Burak Bilgin9
  • Sema Sezgin Göksu10
  • Hacer Demir11
  • Elif Berna Köksoy3
  • Osman Köstek12
  • İsmail Ertürk13
  • Teoman Şakalar14
  • Arzu Yaşar15
  • Görkem Türkkan16
  • Büşra Kasım17
  • Aziz Karaoğlu2
  • Berna Çakmak Öksüzoğlu4
  • Fulden Yumuk6
  • Mehmet Ali Şendur18
  • Hasan Şenol Coşkun10
  • İrfan Çiçin12
  • Nuri Karadurmuş13
  • Özgür Tanrıverdi1
  • Hakan Akbulut3
  • Yüksel Ürün3

1Muğla Sıtkı Koçman University School of Medicine, Medical Oncology, 48000 Muğla, Turkey

2Dokuz Eylül University School of Medicine, Medical Oncology, 35220 İzmir, Turkey

3Ankara University School of Medicine, Medical Oncology, 06560 Ankara Turkey

4Dr. Abdurrahman Yurtarslan Research and Training Hospital, Medical Oncology, 06200 Ankara, Turkey

5Pamukkale University School of Medicine, Medical Oncology, 20160 Denizli, Turkey

6Marmara University School of Medicine, Medical Oncology, 34722 İstanbul, Turkey

7Selçuk University School of Medicine, Medical Oncology, 42250 Konya, Turkey

8Bahçeşehir University School of Medicine, İstanbul and Medical Park İzmir Hospital, Medical Oncology, 34488 İzmir, Turkey

9Atatürk Chest Disease and Chest Surgery Research and Training Hospital, Department of Medical Oncology, 06280 Ankara, Turkey

10Akdeniz University School of Medicine, Medical Oncology, 07070 Antalya, Turkey

11Afyon Kocatepe University School of Medicine, Medical Oncology, 03200 Afyon, Turkey

12Trakya University School of Medicine, Medical Oncology, 22030 Edirne, Turkey

13Gülhane Research and Training Hospital, Medical Oncology, 06010 Ankara, Turkey

14Erciyes University School of Medicine, Medical Oncology, 38280 Kayseri, Turkey

15Kütahya Health Science University, Evliya Çelebi Research and Training Hospital, Medical Oncology, 43100 Kütahya, Turkey

16Muğla Sıtkı Koçman University School of Medicine, Radiation Oncology, 48000 Muğla, Turkey

17Muğla Sıtkı Koçman University School of Medicine, Internal Medicine, 48000 Muğla, Turkey

18Yıldırım Beyazıt University, Atatürk Research and Training Hospital, Medical Oncology, 06760 Ankara, Turkey

DOI: 10.31083/jomh.2021.041 Vol.17,Issue 4,September 2021 pp.128-134

Submitted: 18 January 2021 Accepted: 02 March 2021

Published: 30 September 2021

(This article belongs to the Special Issue Therapy and prognosis of metastatic prostate cancer)

*Corresponding Author(s): Ali Alkan E-mail: alkanali@yahoo.com

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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Ali Alkan,Zeynep Gülsüm Güç,Mustafa Gürbüz,Güliz Özgün,Serkan Değirmencioğlu,Mutlu Doğan,Tuğba Akın Telli,Özge Keskin,Çağatay Arslan,Burak Bilgin,Sema Sezgin Göksu,Hacer Demir,Elif Berna Köksoy,Osman Köstek,İsmail Ertürk,Teoman Şakalar,Arzu Yaşar,Görkem Türkkan,Büşra Kasım,Aziz Karaoğlu,Berna Çakmak Öksüzoğlu,Fulden Yumuk,Mehmet Ali Şendur,Hasan Şenol Coşkun,İrfan Çiçin,Nuri Karadurmuş,Özgür Tanrıverdi,Hakan Akbulut,Yüksel Ürün. Enzalutamide versus Abiraterone Acetate as first-line treatment of castration resistant metastatic prostate cancer in geriatric (≥75) patients. Journal of Men's Health. 2021. 17(4);128-134.

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