Many will have seen the piece by Mary Clare Fischer in the Malecare newsletter [1]; below is the link to the published paper [2].
"Men with advanced prostate cancer and their use of abiraterone or enzalutamide were identified in a 20% sample of the 2010-2017 national Medicare claims.
"The primary composite outcome was the occurrence of a major metabolic or cardiovascular adverse event, defined as an emergency room visit or hospitalization associated with a primary diagnosis of diabetes, hypertension, or cardiovascular disease.
"The secondary composite outcome was the occurrence of a minor metabolic or cardiovascular adverse event, defined as an outpatient visit associated with a primary diagnosis of the aforementioned conditions."
"Compared with men not receiving abiraterone, men receiving abiraterone were at increased risk of both a major composite adverse event (hazard ratio [HR] = 1.77 ...) and a minor composite adverse event (HR = 1.24 ...).
"Compared with men not receiving enzalutamide, men receiving enzalutamide were at an increased risk of a major composite adverse event (HR = 1.22 ///) but not a minor composite adverse event (HR = 1.04 ...)"
This is in addition to any risk posed by classic ADT.
Interesting that the add-on risk for Enza is substantially less than for Abi.
The study reflects "real world" rather than risks reported for clinical trial cohorts.
Many men in our age group have other chronic medical conditions, but PCa itself is associated with metabolic issues. These must be considered before starting either drug IMO.
-Patrick
[1] labblog.uofmhealth.org/lab-...
[2] academic.oup.com/jnci/advan...?
Risk of Metabolic and Cardiovascular Adverse Events With Abiraterone or Enzalutamide Among Men With Advanced Prostate Cancer
Lillian Y Lai, MD, MS, Mary K Oerline, MS, Megan E V Caram, MD, MS, Phoebe A Tsao, MD, Samuel R Kaufman, MA, Brent K Hollenbeck, MD, MS, Vahakn B Shahinian, MD, MS
JNCI: Journal of the National Cancer Institute, djac081, doi.org/10.1093/jnci/djac081
Published: 13 April 2022 Article history
Abstract
Background
Abiraterone and enzalutamide are the most common oral agents for the treatment of men with advanced prostate cancer. To understand their safety profiles in real-world settings, we examined the association between the use of abiraterone or enzalutamide and the risk of metabolic or cardiovascular adverse events while on treatment.
Methods
Men with advanced prostate cancer and their use of abiraterone or enzalutamide were identified in a 20% sample of the 2010-2017 national Medicare claims. The primary composite outcome was the occurrence of a major metabolic or cardiovascular adverse event, defined as an emergency room visit or hospitalization associated with a primary diagnosis of diabetes, hypertension, or cardiovascular disease. The secondary composite outcome was the occurrence of a minor metabolic or cardiovascular adverse event, defined as an outpatient visit associated with a primary diagnosis of the aforementioned conditions. Risks were assessed separately for abiraterone and enzalutamide using Cox regression. All statistical tests were 2-sided.
Results
Compared with men not receiving abiraterone, men receiving abiraterone were at increased risk of both a major composite adverse event (hazard ratio [HR] = 1.77, 95% confidence interval [CI] = 1.53 to 2.05; P < .001) and a minor composite adverse event (HR = 1.24, 95% CI = 1.05 to 1.47; P = .01). Compared with men not receiving enzalutamide, men receiving enzalutamide were at an increased risk of a major composite adverse event (HR = 1.22, 95% CI = 1.01 to 1.48; P = .04) but not a minor composite adverse event (HR = 1.04, 95% CI = 0.83 to 1.30; P = .75).
Conclusion
Careful monitoring and management of men on abiraterone or enzalutamide through team-based approaches are critical.
Xtandi + Zytiga Fails To Deliver
Xtandi and Zytiga Given Together
Xtandi failed suggested Zytiga
Zytiga after Xtandi? 
after xtandi and zytiga fail- 
