Abiraterone acetate versus bicalutamide in combination with gonadotropin releasing hormone antagonist therapy for high risk metastatic hormone sensitive prostate cancer

Takashi Ueda,Yasuhiro Yamada,Osamu Ukimura,Toru Matsugasumi,Saya Ito,Fumiya Hongo,Atsuko Fujihara,Munehiro Ohashi,Koji Okihara,Koji Okihara,Takumi Shiraishi

doi:10.1038/s41598-021-89609-2

Abstract

The objective of this study was to compare the efficacy of abiraterone acetate with that of bicalutamide in combination with gonadotropin-releasing hormone (GnRH) antagonist treatment for patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). A total of 149 patients with mHSPC who underwent treatment at our hospital and affiliated hospitals between December 2013 and July 2020 were retrospectively identified. Fifty patients were administered abiraterone acetate (1000 mg/day) plus prednisolone (5 mg/day) with a GnRH antagonist (degarelix) (group A), and 99 patients were administered bicalutamide (80 mg/day) with a GnRH antagonist (group B). The prostate-specific antigen (PSA) progression-free survival (PSA-PFS) was significantly longer in group A than in group B. Abiraterone acetate therapy and Gleason score were significant independent factors of PSA-PFS. Using propensity score matching, 56 matched patients were obtained. The PSA-PFS (p < 0.001) and overall survival (OS) (p = 0.0071) of patients with high-risk mHSPC were significantly longer in group A of matched patients. Abiraterone acetate therapy and Gleason score were significant independent factors for PSA-PFS in matched patients. The PSA-PFS and OS of patients treated with abiraterone acetate in combination with a GnRH antagonist were significantly better than those treated with bicalutamide.

Highlights

The objective of this study was to compare the efficacy of abiraterone acetate with that of bicalutamide in combination with gonadotropin-releasing hormone (GnRH) antagonist treatment for patients with high-risk metastatic hormone-sensitive prostate cancer
We retrospectively compared the efficacy of abiraterone acetate with that of bicalutamide in combination with GnRH antagonist treatment for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) and found that prostate-specific antigen (PSA)-progression-free survival (PFS) and overall survival (OS) were significantly better in patients treated with abiraterone acetate than in those treated with bicalutamide
These results could lead to an increase in the number of elderly patients with high-risk mHSPC treated with abiraterone acetate

Summary

Introduction

The objective of this study was to compare the efficacy of abiraterone acetate with that of bicalutamide in combination with gonadotropin-releasing hormone (GnRH) antagonist treatment for patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). In Japanese clinical practice guidelines for prostate cancer, combined androgen blockade (CAB) therapy, which involves concurrent use of a gonadotropin-releasing hormone (GnRH) agonist and first-generation antiandrogen, such as bicalutamide, is recommended as the standard first-line therapy for metastatic prostate cancer. Hormonal therapy using abiraterone acetate, a next-generation antiandrogen, was reported to improve overall survival (OS) and radiographic progression-free survival (PFS) in men with high-risk mHSPC who exhibit at least two of the following factors: Gleason score ≥ 8, at least 3 bone lesions, and the presence of visceral metastasis[6]. There have been no reports comparing the efficacy of abiraterone acetate with that of bicalutamide in combination with GnRH antagonist treatment for high-risk mHSPC

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