Prostate cancer: comorbid CVD tied to higher mortality with ADT

  • Lu-Yao G & al.
  • Eur Urol
  • 2 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Comorbid cardiovascular disease (CVD) is tied to higher short-term mortality risk with enzalutamide or abiraterone acetate in elderly patients with advanced prostate cancer.
  • Preexisting hypertension and 1-2 CVDs are associated with higher hospitalization rate in patients previously treated with chemotherapy.

Why this matters

  • Patients with preexisting CVD are ineligible for clinical trials of androgen deprivation therapy (ADT).

Study design

  • 3876 patients aged ≥65 years with advanced prostate cancer treated with abiraterone acetate or enzalutamide; 850 had undergone chemotherapy.
  • Funding: Department of Health of Pennsylvania.

Key results

  • 67% of patients had ≥1 preexisting CVD.
  • 6-month mortality risk was higher with 1-2 vs no preexisting CVDs (relative risk [RR], 1.16; 95% CI, 1.00-1.36) in absence of prior chemotherapy.
  • Risk further increased with presence of ≥3 CVDs in presence (RR, 1.43; 95% CI, 1.04-1.98) and absence of prior chemotherapy (RR, 1.56; 95% CI, 1.29-1.88).
  • Mortality risk was similar with enzalutamide and abiraterone acetate.
  • Hospitalization rates in postchemotherapy patients were higher with preexisting:
    • Hypertension (incidence rate ratio [IRR], 1.38; 95% CI, 1.04-1.82).
    • 1-2 vs no CVD (IRR, 1.43; 95% CI, 1.15-1.78).
  • Among nonchemotherapy patients with ≥3 CVDs, enzalutamide was associated with a lower hospitalization rate than abiraterone acetate (IRR, 0.59; 95% CI, 0.44-0.79).

Limitations

  • Retrospective design.