LATITUDE secondary analysis - Concurrent use of Abiraterone and NSAIDs - higher risk of Prostate Cancer Specific Mortality and inferior OS

[Graham49]

doi.org/10.1200/JCO.2024.42...

”Conclusions: In this secondary analysis, concomitant exposure to 7 classes of medications was not associated with any statistically significant modification of abiraterone effect on OS in de novo high risk mHSPC. Men who received concurrent NSAIDs had a higher risk of PCSM and inferior OS even after adjustment for skeletal metastases burden and pain score. The excess risk of serious cardiovascular adverse events by interaction of abiraterone and exposure to aspirin could be due to reverse causality due to underlying burden of cardiovascular comorbidity in the exposed group.”

[cesanon]

Is this baby aspirin or heavy duty usage?

[JohnInTheMiddle]

This is very interesting - a follow along analysis to extract more information from the Abiraterone-positive LATITUDE study. I take a baby aspirin everyday because there is some evidence that it helps prevent seeding of new metastases. So reading the note you shared (it's so new it was hard to find anything else) was a concern. However it's hard to understand the logic about "reverse causality" - regarding in the study participants having CVD. Is this a case of Stats 101 "correlation is not causation"?

[Maxone73 in reply to JohnInTheMiddle]

The statement suggests that the combination of abi with aspirin was associated with a higher risk of serious cardiovascular events. But, this increase in risk might not be directly caused by the interaction between abi and aspirin. Instead, it could be that the patients who were taking aspirin already had a higher risk of cardiovascular problems to begin with, which is why they were on aspirin.

[JohnInTheMiddle in reply to Maxone73]

I'm so happy you explain this Max. I think I made a post somewhere else on this but I can't remember. Could this be "Stats 101" - "correlation is not causation"? I take a low dose aspirin every day because there is some good research (lab only) that aspirin has a positive effect against metastasis. Apparently it may make it harder for roving cancer cells to successfully find a new home.On the other hand because I'm doing Abiraterone and I wouldn't like to think that I am undermining this fantastic therapy.

[Maxone73 in reply to JohnInTheMiddle]

Thinking about aspirin as well but I think 2-3 times per week

[tango65]

No surprise. Chronic NSAIDs including Celebrex may increase blood pressure, damage the kidneys and predispose patients to GI bleeding.

[Graham49 in reply to tango65]

Yes, I have a kidney transplant and I am not allowed to take NSAIDs.

[tango65 in reply to Graham49]

And it gets worse in many patients who received concomitant zoledronic acid for bone mets or osteopenia/malacia which could also affect the kidneys.

[Maxone73 in reply to tango65]

I was thinking about taking baby aspiring 2-3 per week (the effect as blood thinner lasts for days) but I am on zoledronic acid every 28 days (IV, not oral)...I am having second thoughts