Shah Yash B, Shaver Amy L, Beiriger Jacob, Mehta Sagar, Nikita Nikita, Kelly William Kevin, Freedland Stephen J, Lu-Yao Grace
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Cancers (Basel). 2022 Aug 3;14(15):3773. doi: 10.3390/cancers14153773.
Abiraterone acetate (AA) and enzalutamide (ENZ) are commonly used for metastatic prostate cancer. It is unclear how their outcomes and toxicities vary with patient-specific factors because clinical trials typically exclude patients with significant comorbidities. This study aims to fill this knowledge gap and facilitate informed treatment decision making. A registered protocol utilizing PRISMA scoping review methodology was utilized to identify real-world studies. Of 433 non-duplicated publications, 23 were selected by three independent reviewers. ENZ offered a faster and more frequent biochemical response (30-50% vs. 70-75%), slowed progression (HR 0.66; 95% CI 0.50-0.88), and improved overall survival versus AA. ENZ was associated with more fatigue and neurological adverse effects. Conversely, AA increased risk of cardiovascular- (HR 1.82; 95% CI 1.09-3.05) and heart failure-related (HR 2.88; 95% CI 1.09-7.63) hospitalizations. Ultimately, AA was associated with increased length of hospital stay, emergency department visits, and hospitalizations (HR 1.26; 95% CI 1.04-1.53). Accordingly, total costs were higher for AA, although pharmacy costs alone were higher for ENZ. Existing data suggest that AA and ENZ have important differences in outcomes including toxicities, response, disease progression, and survival. Additionally, adherence, healthcare utilization, and costs differ. Further investigation is warranted to inform treatment decisions which optimize patient outcomes.
醋酸阿比特龙（AA）和恩杂鲁胺（ENZ）常用于转移性前列腺癌。目前尚不清楚它们的疗效和毒性如何因患者个体因素而异，因为临床试验通常会排除有严重合并症的患者。本研究旨在填补这一知识空白，并促进明智的治疗决策。我们采用了一种利用PRISMA范围综述方法的注册方案来识别真实世界研究。在433篇非重复出版物中，三位独立评审员挑选出了23篇。与AA相比，ENZ能带来更快且更频繁的生化反应（30 - 50%对70 - 75%）、减缓疾病进展（风险比[HR] 0.66；95%置信区间[CI] 0.50 - 0.88）以及改善总生存期。ENZ与更多的疲劳和神经不良反应相关。相反，AA增加了心血管相关住院（HR 1.82；95% CI 1.09 - 3.05）和心力衰竭相关住院（HR 2.88；95% CI 1.09 - 7.63）的风险。最终，AA与住院时间延长、急诊就诊次数和住院次数增加相关（HR 1.26；95% CI 1.04 - 1.53）。因此，尽管仅药品成本ENZ更高，但AA的总成本更高。现有数据表明，AA和ENZ在疗效方面存在重要差异，包括毒性、反应、疾病进展和生存期。此外，依从性、医疗资源利用和成本也有所不同。有必要进行进一步调查，以指导治疗决策，从而优化患者的治疗效果。
