Duration of Treatment ... with Abiraterone Acetate or Enzalutamide.

[pjoshea13]

New study below.

A week ago I posted a study:

"Abiraterone or Enzalutamide in Advanced CRPC."

"There is strong evidence that enzalutamide outperforms AA with prednisone in terms of radiographic PFS and PSA progression and PSA response rate but not OS in the pre and post-docetaxel settings."

In the current study:

"... patients initiated on AA, compared with those initiated on ENZ, had a longer combined duration of mCRPC or prostate cancer treatments."

-Patrick

ncbi.nlm.nih.gov/pubmed/281...

J Manag Care Spec Pharm. 2017 Feb;23(2):225-235. doi: 10.18553/jmcp.2016.16233. Epub 2016 Dec 7.

Duration of Treatment in Prostate Cancer Patients Treated with Abiraterone Acetate or Enzalutamide.

Pilon D1, Behl AS2, Ellis LA2, Emond B1, Lefebvre P1, Dawson NA3.

Author information

11 Groupe d'analyse, Ltée, Montréal, QC, Canada.

22 Janssen Scientific Affairs, Horsham, Pennsylvania.

33 Georgetown University Lombardi Comprehensive Cancer Center, Washington DC.

Abstract

BACKGROUND:

Abiraterone acetate (AA) and enzalutamide (ENZ) are oral therapies offering survival benefit to metastatic castration-resistant prostate cancer (mCRPC) patients. Despite the availability of multiple treatment options for mCRPC, there is a lack of information on the effect that being initiated on AA or ENZ has on the combined prostate cancer treatment duration.

OBJECTIVE:

To compare the combined duration of prostate cancer treatments of patients initiated on AA with that of patients initiated on ENZ.

METHODS:

Truven Health MarketScan Research Databases from March 2012 to December 2014 were used to identify males with prostate cancer initiated on AA or ENZ (index therapy). Baseline characteristics were assessed during the 6 months pre-index. Inverse probability of treatment weights (IPTWs) were used to reduce baseline confounding. Treatment duration spanned from the index date to the earliest of treatment discontinuation (defined as a > 60-day gap in treatment), 24 months post-index, health plan disenrollment, or end of data. Weighted Kaplan-Meier and Cox proportional hazard models were used to compare the combined duration of mCRPC treatments (AA, ENZ, chemotherapy, sipuleucel-T, and radium 223) and any prostate cancer treatments (mCRPC, hormonal, and corticosteroid treatments) between patients initiated on either AA or ENZ.

RESULTS:

A total of 2,591 patients initiated on AA and 807 patients initiated on ENZ were selected for the study. Patients' characteristics were generally well balanced after IPTW. At 3 months, patients initiated on AA were associated with fewer discontinuations of mCRPC treatments (hazard ratio [HR] = 0.73, P = 0.004) or of any prostate cancer treatments (HR = 0.61, P = 0.002), compared with patients initiated on ENZ. This result was maintained at 6, 9, 12, 18, and 24 months for mCRPC treatments (HR = 0.75, P < 0.001) and for any prostate cancer treatments (HR = 0.69, P < 0.001). Median duration of mCRPC treatments was 4.1 months longer for patients initiated on AA compared with those initiated on ENZ (18.3 vs. 14.2 months, P < 0.001) and similarly, the median duration of any prostate cancer treatment was longer for patients initiated on AA compared with those initiated on ENZ (not reached vs. 22.2 months, P < 0.001).

CONCLUSIONS:

In this study, patients initiated on AA, compared with those initiated on ENZ, had a longer combined duration of mCRPC or prostate cancer treatments.

DISCLOSURES:

This research was funded by Janssen Scientific Affairs. Pilon, Emond, and Lefebvre are employees of Analysis Group, a consulting company that has received research grants from Janssen Scientific Affairs. Behl and Ellis are employees of Janssen Scientific Affairs and stockholders in Johnson & Johnson. Dawson is on the speakers bureau for Janssen, Astellas, and Sanofi Aventis. Emond reports grants from Regeneron, Bristol-Myers Squibb, GlaxoSmithKline, Aegerion, Bayer, Novartis, Allergan, Millenium, and Genentech. Pilon reports grants from Novartis, GlaxoSmithKline, Pfizer, and Bayer. Lefebvre reports grants from GlaxoSmithKline, Novartis, Bayer, Medtronic, Noven, and Novo Nordisk. Study concept and design were contributed primarily by Pilon and Lefebvre, along with the other authors. Pilon, Emond, and Lefebre collected the data, and data interpretation was performed by Behl, Lefebvre, and Dawson, along with Pilon, Ellis, and Emond, The manuscript was written by Pilon, Emond, and Lefebvre and revised by Behl, Ellis, and Dawson.

PMID: 28125362 DOI: 10.18553/jmcp.2016.16233

[PubMed - in process]

[Beauxman]

Why should we care about duration of treatments? Treatments could end due to a great number of things: death, remission, side effects. I don't see the point of this study to a patient. Maybe it is useful to an insurance company. Dead men don't incur new expenses.

[Neal-Snyder in reply to Beauxman]

This study involved a large number of patients. The characteristics of those who started on AA were well matched with the characteristics of those who started on ENZ. The whole point is that those who started on AA did not reach the end of treatments as soon, whether due to death or side effects. I don't think remission without continued treatment is a factor at this stage of PCa.

So this is highly relevant to patients who are choosing which of the two treatments to begin with. I started with, & am still on, AA, so I'm glad to hear that was the right choice. Med onc's who keep up with the scientific literature should advise patients accordingly.

As to insurance companies, if any company tried to force oncologists to start with ENZ over AA, in violation of the doctors' medical ethics, & probably of the insurance company's state licensing, that should cause investigations & negative publicity.

[Beauxman]

The last sentence of the study document is "Further research is needed to assess the overall survival of patients initiated on AA or ENZ in the real-world setting and its link to the duration of treatment."