Introduction: To provide a snapshot of toxicities and oncologic outcomes of Abiraterone (AA) and Enzalutamide (EZ) in a chemo-naïve metastatic Castration Resistant Prostate Cancer (mCPRC) population from a longitudinal real-life multicenter cohort.
Methods: We prospectively collected data on chemo-naïve mCRPC patients treated with AA or EZ. Primary outcomes were PSA response, oncologic outcomes and toxicity profile. The KaplanMeier method was used to compare differences in terms of progression-free survival (PFS) between AA vs EZ and high- vs low-volume disease cohorts. Univariable and multivariable Cox regression analyses were performed to identify predictors of PFS. Toxicity, PSA-response rates and oncologic outcomes on second-line were compared with those observed on first-line.
Results: Out of 137 patients, 88 received AA, 49 EZ. On first-line, patients receiving EZ had significantly higher PSA-response compared with AA (95.9%vs67%, p<0.001), comparable toxicity rate (10.2%vs16.3%, p=0.437) and PFS probabilities (p=0.145). Baseline PSA and high-volume disease were predictors of lower PFS probabilities at univariable analysis (p=0.027band p=0.007, respectively). Overall, 28 patients shifted to a second-line therapy (EZ or radiometabolic therapy). Toxicity and PSA-response rates on second-line were comparable to those observed on first-line (11.1%vs12.4%, p=0.77; 73.1%vs77.4%, p=0.62, respectively); 2-yr PFS, cancer-specific and overall survival probabilities were comparable to those displayed in first-line cohort (12.1%vs16.2%,p=0.07; 85.7%vs86.4%,p=0.98; 71%vs80.3%,p=0.66, respectively).
Conclusions: Toxicity profile, PSA-response rate and oncological outcomes were comparable between first-line and second-line courses in patients treated with either AA or EZ for mCRPC. Our findings showed the tolerability and oncological effectiveness, when feasible, of two lines of therapy other than chemotherapy. Source of