Abiraterone acetate, enzalutamide and their sequence for CRPC: Adherence, survival, .........

[pjoshea13]

New Austrian study, below.

"The database of the largest public insurance company in Austria was analyzed. All CRPC patients with at least one prescription of AA and/or ENZ between September 2013 and August 2016 in the pre-chemotherapy and post-chemotherapy setting were extracted and matched to the Austrian death and hospital admission statistics."

The stats are for "a real-life setting", which may vary by country.

Some men find survival stats to be upsetting. Read no further in that case.

...

Others want to see numbers however grim they might be, which is why I am posting this - even if they are a minority.

-Patrick

ncbi.nlm.nih.gov/pubmed/303...

Wien Klin Wochenschr. 2018 Oct 15. doi: 10.1007/s00508-018-1394-0. [Epub ahead of print]

Abiraterone acetate, enzalutamide and their sequence for castration-resistant prostate cancer : Adherence, survival and hospitalization analysis of a medical claims database.

Al-Ali BM1, Eredics K1, Madersbacher S1,2, Schauer I3.

Author information

Abstract

OBJECTIVE:

To analyze drug adherence, overall survival (OS) and hospitalization rates of patients with castration-resistant prostate cancer (CRPC) treated with arbiraterone acetate (AA), enzalutamide (ENZ) and their sequence in a real-life setting.

METHODS:

The database of the largest public insurance company in Austria was analyzed. All CRPC patients with at least one prescription of AA and/or ENZ between September 2013 and August 2016 in the pre-chemotherapy and post-chemotherapy setting were extracted and matched to the Austrian death and hospital admission statistics. Drug adherence was estimated by the medication possession ratio (MPR).

RESULTS:

Data of 457 patients (mean age: 74.4 ± 8.5 years) were analyzed. The mean MPR was 90% for AA, 85% for ENZ and 88% for the sequence therapy cohort. The median overall survival (OS) of the entire cohort was 21 months: 15 months for AA, 24 months for ENZ, 26 months for the sequence group, and 10 months for the sequence group after switching. In the post-chemotherapy setting, the median OS was 14 months in AA treatment (mean: 15.8 ± 0.9 months), 19 months in the ENZ treatment (mean: 17.2 ± 1.4 months) and 25 months in the sequence group (mean: 22.7 ± 0.8 months). Median OS in the pre-chemotherapy setting was 25 months (mean: 21.5 ± 1.1 months), 18 months in AA treatment group (mean: 18.9 ± 1.5 months) and 17 months in ENZ treatment group (mean: 18.2 ± 1.9 months). Only 43 (9.4%) patients were not hospitalized during the course of the study. On average patients spent 13% of their remaining life span in hospital care (median 8%, range: 1-34%).

CONCLUSION:

This Austrian prescription database allows some insights into the outcome of CRPC patients treated with AA and ENZ and their sequence in a real-life setting. Drug adherence was satisfactory, OS was shorter for AA and ENZ as compared to the pivotal phase III trials.

KEYWORDS:

Abiraterone acetat (AA); Castration-resistant prostate cancer (CRPC); Enzalutamide (ENZ); Medication adherence; Overall survival (OS)

PMID: 30324300 DOI: 10.1007/s00508-018-1394-0

[snoraste]

It is grim, but I'm glad you posted it. It is a reminder of the effectiveness of Abi/Enz in a CRPC setting, and perhaps should be a motivation for seeking alternate treatments at the onset of CRPC. For me, at least, it also highlights the value of delaying resistance, be it through an intermittent therapy, or use of proper supplements (metformin/statin/etc)

[BigRich]

The key word is median. I am blessed. I have always outlived the odds. I will live another seven years. A lifetime to me. I will begin my 21st year in December.

Rich

[Grumpyswife]

Also, am I understanding correctly that it appears to show that one has longer survival using Abiraterone pre chemo and enzalutamide post chemo?

[TommyTV]

I’ve not read the entire article, so excuse my ignorance.

Is this a study of Ab and Enz taken after the PCa becomes CRPC?

If so, I thought the median was 15 months in the U.K.

Personally, I’m in the STAMPEDE trial of Abiraterone taken at dx with Zoladex or Lupron. The outcomes here are dramatically different. I’m just approaching 7 years in the trial, which is about 4 years longer than the best estimate of OS taking Zoladex alone. It would seem that this combination of drugs delays CRPC by a considerable amount of time.

[Grumpyswife in reply to TommyTV]

Yes it’s after becoming CRPC and states the results give shorter overall survival then previous pivotal trials did.

[Hidden]

They talk about the "sequence group" having a better OS, but there is no detail about this group, IE. which sequence, etc. Is that information available?

I'd like to know because I'm currently on Zytiga and hoping to go to Xtandi when it stops working. From what I've read so far, the Zytiga-Xtandi sequence is better, but I'd like to learn more about that.

[Mormon1]

Bull. Depends on who pays for the study.