Mortality and Hospitalization Risk Following Oral Androgen Signaling Inhibitors Among Men with Advanced Prostate Cancer by Pre-existing Cardiovascular Comorbidities.
Abiraterone Acetate
/ administration & dosage
Administration, Oral
Aged
Aged, 80 and over
Androgen Antagonists
/ administration & dosage
Antineoplastic Agents
/ administration & dosage
Benzamides
Cardiovascular Diseases
/ complications
Hospitalization
/ statistics & numerical data
Humans
Male
Neoplasm Staging
Nitriles
Phenylthiohydantoin
/ administration & dosage
Prostatic Neoplasms
/ complications
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Cardiovascular diseases
Elderly population
Hospitalization
Population-based study
Prostate cancer
Short-term mortality
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
22
02
2019
accepted:
12
07
2019
pubmed:
20
8
2019
medline:
19
3
2021
entrez:
18
8
2019
Statut:
ppublish
Résumé
Elderly patients (≥65yr) with advanced prostate cancer and cardiovascular disease (CVD) conditions are often excluded from clinical trials of abiraterone acetate (AA) or enzalutamide (ENZ). Consequently, little is known about the effects of these medications on these vulnerable patients. To assess the short-term outcomes of AA and ENZ in patients with pre-existing CVDs. A population-based retrospective study. The Surveillance, Epidemiology, and End Results-Medicare-linked database was used to identify prostate cancer patients using AA or ENZ. The primary endpoint was 6-mo all-cause mortality, analyzed using modified Poisson regression modeling of relative risk (RR) adjusted for confounders and comorbidities. Among eligible patients (2845 with AA and 1031 with ENZ), 67% had at least one pre-existing CVD. Compared with those without pre-existing CVDs, having one to two pre-existing CVDs was associated with 16% higher 6-mo mortality (RR=1.16, 95% confidence interval [CI]: 1.00-1.36), and the risk increased further among those having three or more CVDs (RR=1.56, 95% CI: 1.29-1.88). Most of the differences in survival of patients with pre-existing CVD condition occurred within the first 6mo of treatment. After treatment with AA or ENZ, elderly prostate cancer patients with pre-existing CVDs experienced higher short-term mortality than otherwise similar patients without CVDs. Mortality associated with CVDs did not depend on having received AA versus ENZ. Patients with pre-existing cardiovascular diseases (CVDs) experienced higher short-term mortality after abiraterone acetate or enzalutamide than those without pre-existing CVDs. It is recommended that a multidisciplinary team, including a cardiologist, evaluate patients having pre-existing CVDs in the process of making treatment decisions and monitoring potential side effects.
Sections du résumé
BACKGROUND
Elderly patients (≥65yr) with advanced prostate cancer and cardiovascular disease (CVD) conditions are often excluded from clinical trials of abiraterone acetate (AA) or enzalutamide (ENZ). Consequently, little is known about the effects of these medications on these vulnerable patients.
OBJECTIVE
To assess the short-term outcomes of AA and ENZ in patients with pre-existing CVDs.
DESIGN, SETTING, AND PARTICIPANTS
A population-based retrospective study. The Surveillance, Epidemiology, and End Results-Medicare-linked database was used to identify prostate cancer patients using AA or ENZ.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary endpoint was 6-mo all-cause mortality, analyzed using modified Poisson regression modeling of relative risk (RR) adjusted for confounders and comorbidities.
RESULTS AND LIMITATIONS
Among eligible patients (2845 with AA and 1031 with ENZ), 67% had at least one pre-existing CVD. Compared with those without pre-existing CVDs, having one to two pre-existing CVDs was associated with 16% higher 6-mo mortality (RR=1.16, 95% confidence interval [CI]: 1.00-1.36), and the risk increased further among those having three or more CVDs (RR=1.56, 95% CI: 1.29-1.88). Most of the differences in survival of patients with pre-existing CVD condition occurred within the first 6mo of treatment.
CONCLUSIONS
After treatment with AA or ENZ, elderly prostate cancer patients with pre-existing CVDs experienced higher short-term mortality than otherwise similar patients without CVDs. Mortality associated with CVDs did not depend on having received AA versus ENZ.
PATIENT SUMMARY
Patients with pre-existing cardiovascular diseases (CVDs) experienced higher short-term mortality after abiraterone acetate or enzalutamide than those without pre-existing CVDs. It is recommended that a multidisciplinary team, including a cardiologist, evaluate patients having pre-existing CVDs in the process of making treatment decisions and monitoring potential side effects.
Identifiants
pubmed: 31420248
pii: S0302-2838(19)30585-8
doi: 10.1016/j.eururo.2019.07.031
pmc: PMC6980462
mid: NIHMS1536118
pii:
doi:
Substances chimiques
Androgen Antagonists
0
Antineoplastic Agents
0
Benzamides
0
Nitriles
0
Phenylthiohydantoin
2010-15-3
enzalutamide
93T0T9GKNU
Abiraterone Acetate
EM5OCB9YJ6
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
158-166Subventions
Organisme : NCI NIH HHS
ID : P20 CA233255
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA056036
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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