Our Experience with Abiraterone and Enzalutamide in the Treatment of Metastatic Castration-Resistant Prostate Cancer: Retrospective Real-Life Data
Received Date : 24 Aug 2021
Accepted Date : 28 Nov 2021
Available Online : 10 Dec 2021
Doi: 10.37047/jos.2021-85879 - Article's Language: EN
J Oncol Sci. 2022;8(1):7-13
This is an open access article under the CC BY-NC-ND license
Objective: In recent years, agents targeting the androgen signaling pathway, such as abiraterone and enzalutamide, have become increasingly crucial in the treatment of metastatic castration-resistant prostate cancer (mCRPC). This study aimed to compare the effectiveness of both agents retrospectively. Material and Methods: Patients with the diagnosis of mCRPC who received abiraterone (ABI group) or enzalutamide (ENZA group) and who were followed up and treated in our clinics were analyzed retrospectively. Results: A total of 59 patients, 23 receiving abiraterone and 36 enzalutamide, were included in the study. Moreover, the prostate-specific antigen (PSA) level reduced by more than 50% in 33 (14 in the ABI group and 19 in the ENZA group) patients. The median progression-free survival (PFS) and overall survival-2 (OS-2) were 7.46±2.08 months and 13.60±6.19 months in the ABI group and 8.80±4.21 months and 21.03±3.84 months in the ENZA group (p=0.448; p=0.571), respectively. When the Cox regression analysis was performed, PSA reduction of more than 50% was statistically significant for OS-2 but not for PFS (p=0.023). Conclusion: Both abiraterone and enzalutamide are effective treatment agents for mCRPC. The decrease in the PSA value is a crucial predictive marker in evaluating the effectiveness of the treatment.
  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. Erratum in: CA Cancer J Clin. 2020;70(4):313. [Crossref]  [PubMed] 
  2. Halabi S, Lin CY, Kelly WK, et al. Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer. J Clin Oncol. 2014;32(7):671-677. Erratum in: J Clin Oncol. 2014;32(13):1387. [Crossref]  [PubMed]  [PMC] 
  3. Nakazawa M, Paller C, Kyprianou N. Mechanisms of therapeutic resistance in prostate cancer. Curr Oncol Rep. 2017;19(2):13. [Crossref]  [PubMed]  [PMC] 
  4. Fang M, Nakazawa M, Antonarakis ES, Li C. Efficacy of abiraterone and enzalutamide in pre- and postdocetaxel castration-resistant prostate cancer: a trial-level meta-analysis. Prostate Cancer. 2017;2017:8560827. [Crossref]  [PubMed]  [PMC] 
  5. Fizazi K, Scher HI, Molina A, et al; COU-AA-301 Investigators. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2012;13(10):983-992. Erratum in: Lancet Oncol. 2012;13(11):e464. Erratum in: Lancet Oncol. 2014;15(9):e365. [Crossref]  [PubMed] 
  6. Scher HI, Fizazi K, Saad F, et al; AFFIRM Investigators. Increased survival with enzalutami de in prostate cancer after chemotherapy. N Engl J Med. 2012;367(13):1187-1197. [Crossref]  [PubMed] 
  7. Ryan CJ, Smith MR, Fizazi K, et al; COU-AA-302 Investigators. Abiraterone acetate plus pred nisone versus placebo plus prednisone in che motherapy-naive men with metastatic castra tion-resistant prostate cancer (COU-AA-302): fi nal overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015;16(2):152-160. [Crossref]  [PubMed] 
  8. Beer TM, Armstrong AJ, Rathkopf DE, et al; PREVAIL Investigators. Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med. 2014;371(5):424-433. [PubMed]  [PMC] 
  9. Armstrong AJ, Al-Adhami M, Lin P, et al. Association between new unconfirmed bone lesions and outcomes in men with metastatic castration-resistant prostate cancer treated with enzalutamide: secondary analysis of the PREVAIL and AFFIRM randomized clinical trials. JAMA Oncol. 2020;6(2):217-225. [Crossref]  [PubMed]  [PMC] 
  10. Miller K, Carles J, Gschwend JE, Van Poppel H, Diels J, Brookman-May SD. The phase 3 COU-AA-302 study of abiraterone acetate plus prednisone in men with chemotherapy-naïve metastatic castration-resistant prostate cancer: stratified analysis based on pain, prostate-specific antigen, and Gleason score. Eur Urol. 2018;74(1):17-23. [Crossref]  [PubMed] 
  11. Halabi S, Kelly WK, Ma H, et al. Meta-analysis evaluating the impact of site of metastasis on overall survival in men with castration-resistant prostate cancer. J Clin Oncol. 2016; 34(14):1652-1659. [PubMed]  [PMC]