Treatment-Emergent Co-Morbidities and Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Abiraterone or Enzalutamide

Yi-Ting Lin; Yen-Chun Huang; Chih-Kuan Liu; Tian-Shyug Lee; Mingchih Chen; Yu-Ning Chien

doi:10.3389/fphar.2021.669236

Treatment-Emergent Co-Morbidities and Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Abiraterone or Enzalutamide

Front Pharmacol. 2021 May 18:12:669236. doi: 10.3389/fphar.2021.669236. eCollection 2021.

Authors

Yi-Ting Lin^{1

2

3}, Yen-Chun Huang^{1

2}, Chih-Kuan Liu^{1

4}, Tian-Shyug Lee^{1

2}, Mingchih Chen^{1

2}, Yu-Ning Chien^{2

5}

Affiliations

¹ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.
² AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan.
³ Department of Urology, St. Joseph Hospital, Yunlin County, Taiwan.
⁴ Department of Urology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
⁵ College of Medicine Fu Jen Catholic University Master Program of Big Data Analysis in Biomedicine, New Taipei City, Taiwan.

Abstract

Secondary hormone therapy, abiraterone and enzalutamide, has improved outcomes for metastatic castration-resistant prostate cancer (mCRPC) and prolonged patients' lives significantly. Various studies have compared the cancer-related outcomes, adverse effects, and drug-induced comorbidities in patients with mCRPC who are treated with abiraterone or enzalutamide. However, few studies have explored associations between survival and comorbidities or comprehensive analyzed newly developed comorbidities during and after secondary hormone therapy. We attempted to clarify whether the Charlson comorbidity index (CCI) overall or itemized is predictive for overall survival, and we compared newly developed comorbidities between abiraterone and enzalutamide groups. We extracted data about expenses and comorbidities for patients who have mCRPC, received abiraterone and enzalutamide and met pre-examination operation criteria between September 2016 and December 2017 from the Taiwan National Health Insurance database. A total of 1153 patients with mCRPC who received abiraterone (n = 782) or enzalutamide (n = 371) with or without previous chemotherapy were included. We used the propensity score to match confounding factors, including age, pre-existing comorbidities, and precipitating factors for comorbidity (e.g., hypertension, hyperlipidemia), to eliminate selection bias in the comparison of newly developed comorbidities. Cox regression analysis was used for overall survival. We found that enzalutamide is superior to abiraterone with regard to overall survival. Our study revealed that there is no statistically significant difference in development of new comorbidities between abiraterone and enzalutamide group. Moreover, the CCI score, rather than any single item of the CCI, was a statistically significant predictor for overall survival.

Keywords: abiraterone; charlson comorbidity index; enzalutamide; enzalutamide overall survival; metastatic castration resistant prostate cancer; national health insurance research database.