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Kuijper SC, Besseling J, Klausch T, Slingerland M, van der Zijden CJ, Kouwenhoven EA, Beerepoot LV, Mohammad NH, Klarenbeek BR, Verhoeven RHA, van Laarhoven HWM. Assessing real-world representativeness of prospective registry cohorts in oncology: insights from patients with esophagogastric cancer. J Clin Epidemiol 2023; 164:65-75. [PMID: 37871837 DOI: 10.1016/j.jclinepi.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study aimed to explore the real-world representativeness of a prospective registry cohort with active accrual in oncology, applying a representativeness metric that is novel to health care. STUDY DESIGN AND SETTING We used data from the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP) registry and from the population-based Netherlands Cancer Registry (NCR). We used Representativeness-indicators (R-indicators) and overall survival to investigate the degree to which the POCOP cohort and clinically relevant subgroups were a representative sample compared to the NCR database. Calibration using inverse propensity score weighting was applied to correct differences between POCOP and NCR. RESULTS The R-indicator of the entire POCOP registry was 0.72 95% confidence interval [0.71, 0.73]. Representativeness of palliative patients was higher than that of potentially curable patients (R-indicator 0.88 [0.85, 0.90] and 0.70 [0.68, 0.71], respectively). Stratification to clinically relevant subgroups based on treatment resulted in higher R-indicators of the respective subgroups. Both after stratification and calibration weighting survival estimates in the POCOP registry were more similar to that in the NCR population. CONCLUSION This study demonstrated the assessment of real-world representativeness of patients who participated in a prospective registry cohort and showed that real-world representativeness improved when the variability in treatment was accounted for.
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Affiliation(s)
- Steven C Kuijper
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Joost Besseling
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Thomas Klausch
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Laurens V Beerepoot
- Department of Medical Oncology, Elisabeth Tweesteden Ziekenhuis and EMBRAZE Cancer Network, Tilburg, The Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
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Hettle R, Mihai A, Lang SH, Tatman S, Swift SL. Real-world outcomes for first line next-generation hormonal agents in metastatic prostate cancer: a systematic review. Future Oncol 2023; 19:2425-2443. [PMID: 37681288 DOI: 10.2217/fon-2023-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Aim: This review aims to summarize published evidence on the real-world (RW) outcomes of abiraterone or enzalutamide in first-line metastatic castration-resistant prostate cancer. Materials & methods: Studies reporting on RW effectiveness, safety, economic and/or health-related quality of life outcomes were identified by systematic literature review (2011-2021, incl. Embase®, MEDLINE®) and presented in a qualitative synthesis. Risk of bias was assessed using ROBINS-I or the Molinier checklist. Results: 88 studies (n = 83,427 patients) were included. Median progression-free (40 studies) and overall survival (38 studies) ranged from 3.7 to 20.9 months and 9.8 to 45 months, respectively. Survival, safety and economic outcomes were similar across individual treatments, while limited health-related quality of life evidence suggested improvements with abiraterone. Risk of bias was moderate to high. Conclusion: RW outcomes in first-line metastatic castration-resistant prostate cancer remain poor despite treatment, highlighting an unmet need for new regimens. This review was supported by AstraZeneca and Merck Sharp & Dohme.
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Affiliation(s)
- Robert Hettle
- Payer Simulation & Analytics, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Adela Mihai
- Health Economics & Payer Evidence, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Shona H Lang
- Mtech Access, York, North Yorkshire, YO10 5NY, UK
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Neerhut T, Shin BNH, Rhee H, Chung E. A review of the objective cognitive function measurements in males receiving hormonal therapy for prostate cancer. Investig Clin Urol 2023; 64:521-540. [PMID: 37932563 PMCID: PMC10630686 DOI: 10.4111/icu.20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Prostate cancer (PC) is more common in the older population and the use of hormonal therapy in PC can increase medical frailty and cognitive decline. This narrative review examines the impact of androgen deprivation therapies (ADTs) and next-generational hormonal therapies (NGHT) on cognitive function outcomes amongst patients with hormone-sensitive or castrate-resistant PC. MATERIALS AND METHODS Six electronic databases were searched from January 2000 to June 2022 for quantitative studies to evaluate the impacts of hormonal therapies (ADT, combined androgen blockade, and NGHT) on cognitive functions in men with PC. RESULTS Of the 36 studies identified, 20 studies reported no effect of hormonal therapies on any cognitive domain while 16 studies found possible declines in at least one domain. The domains assessed were highly variable and objective assessment measurements were not standardized or widely adopted. While the results have been inconsistent, a relationship between declining androgen levels and poorer performances in the visuospatial and visual memory domains has been highlighted. It was not possible to distinguish the degree of cognitive parameter changes between the populations of hormone-sensitive and castrate-resistant PC. CONCLUSIONS While the exact impact of ADT and NGHT on cognitive function in men with PC remains controversial, appropriate care should be undertaken especially in older and frail individuals, specifically in those with progressive or established visuospatial or visual memory deficits.
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Affiliation(s)
- Thomas Neerhut
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Brian Ng Hung Shin
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
- AndroUrology Centre, Brisbane, QLD, Australia.
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4
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Procopio G, Chiuri V, Giordano M, Alitto A, Maisano R, Bordonaro R, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico G, Guglielmini P, Carella C, Nova P, Aglietta M, Schips L, Beccaglia P, Sciarra A, Livi L, Santini D, Procopio G, Chiuri V, Mantini G, Roberto Bordonaro RM, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico GM, Guglielmini PF, Santini D, Naglieri E, Fagnani D, Aglietta M, Livi L, Schips L, Passalacqua R, Fiore M, D'Angelillo RM, Ceresoli GL, Magrini S, Rondonotti D, Mirone V, Ferriero MC, Sciarra A, Acquati M, Boccardo F, Scagliotti GV, Mencoboni M, De Giorgi U, Micheletti G, Lanzetta G, Sartori D, Carlini P, Soto Parra HJ, Battaglia M, Uricchio F, Bernardo A, De Lisa A, Carrieri G, Ardizzoia A, Aieta M, Pisconti S, Marchetti P, Paiar F. Real-world experience of abiraterone acetate plus prednisone in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: long-term results of the prospective ABItude study. ESMO Open 2022; 7:100431. [PMID: 35405438 PMCID: PMC9058899 DOI: 10.1016/j.esmoop.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Limited real-world data exist on the effectiveness and safety of abiraterone acetate plus prednisone (abiraterone hereafter) in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) naive to chemotherapy. Most of the few available studies had a retrospective design and included a small number of patients. In the interim analysis of the ABItude study, abiraterone showed good clinical effectiveness and safety profile in the chemotherapy-naive setting over a median follow-up of 18 months. Patients and methods We evaluated clinical and patient-reported outcomes (PROs) of chemotherapy-naive mCRPC patients treated with abiraterone as for clinical practice in the Italian, observational, prospective, multicentric ABItude study. mCRPC patients were enrolled at abiraterone start (February 2016-June 2017) and followed up for 3 years; clinical endpoints and PROs, including quality of life (QoL) and pain, were prospectively collected. Kaplan–Meier curves were estimated. Results Of the 481 patients enrolled, 454 were assessable for final study analyses. At abiraterone start, the median age was 77 years, with 58.6% elderly patients and 69% having at least one comorbidity (57.5% cardiovascular diseases). Visceral metastases were present in 8.4% of patients. Over a median follow-up of 24.8 months, median progression-free survival (any progression reported by the investigators), time to abiraterone discontinuation, and overall survival were, respectively, 17.3 months [95% confidence interval (CI) 14.1-19.4 months], 16.0 months (95% CI 13.1-18.2 months), and 37.3 months (95% CI 36.5 months-not estimable); 64.2% of patients achieved ≥50% reduction in prostate-specific antigen. QoL assessed by Functional Assessment of Cancer Therapy—Prostate, the European Quality of Life 5 Dimensions 3 Level, and European Quality of Life Visual Analog Scale remained stable during treatment. Median time to pain progression according to Brief Pain Inventory data was 31.1 months (95% CI 24.8 months-not estimable). Sixty-two patients (13.1%) had at least one adverse drug reaction (ADR) and 8 (1.7%) one serious ADR. Conclusion With longer follow-up, abiraterone therapy remains safe, well tolerated, and active in a large unselected population. A prospective real-life study of abiraterone acetate in mCRPC patients. In 481 chemotherapy-naive mCRPC patients (median follow-up: 25 months), abiraterone plus prednisone was effective and safe. QoL, measured with various tools, remained stable during treatment with abiraterone plus prednisone. The median time to pain progression was 31.1 months.
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Assessment and Management of Cognitive Function in Patients with Prostate Cancer Treated with Second-Generation Androgen Receptor Pathway Inhibitors. CNS Drugs 2022; 36:419-449. [PMID: 35522374 PMCID: PMC9073450 DOI: 10.1007/s40263-022-00913-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.
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Nowakowska MK, Lei X, Wehner MR, Corn PG, Giordano SH, Nead KT. Association of Second-generation Antiandrogens With Depression Among Patients With Prostate Cancer. JAMA Netw Open 2021; 4:e2140803. [PMID: 34940861 PMCID: PMC8703250 DOI: 10.1001/jamanetworkopen.2021.40803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Previous studies have shown a consistent association between hormone therapy (HT), such as androgen deprivation therapy, to treat prostate cancer and depression risk. However, the association between second-generation antiandrogens (AAs) and depression is unknown. OBJECTIVE To test the a priori hypothesis that second-generation AAs are associated with an increased risk of depression, including compared with traditional forms of HT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed patients aged 66 years and older who were diagnosed with prostate cancer without a second cancer in 12 months from January 2011 to December 2015. Patients with continuous Medicare Parts A, B, and D coverage were included. Individuals who received any form of HT prior to prostate cancer diagnosis and those previously diagnosed with depression were excluded. Data were collected from the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked databases. Data were analyzed from February to May 2021. EXPOSURES The following treatment groups were compared: (1) no HT group, (2) traditional HT group (HT without second-generation AA exposure), and (3) second-generation AA group. MAIN OUTCOMES AND MEASURES Risk of depression in the second-generation AA group compared with the no HT and traditional HT groups, determined prior to data collection, stratified by diagnosis stage. RESULTS Of 210 804 patients diagnosed with prostate cancer during the study window, 30 069 men (11 484 [38%] aged 66-70 years; 22 594 [75%] White) who met inclusion criteria were identified. Overall, 17 710 (59%) received no HT, 11 311 (38%) received traditional HT only, and 1048 (3%) received a second-generation AA. Those receiving a second-generation AA were more likely to be older (aged ≥81 years: second-generation AA group, 246 [24%]; traditional HT group, 1997 [18%]; no HT group, 1173 [7%]) and present with advanced disease (eg, distant disease: second-generation AA group, 562 [24%]; traditional HT group, 876 [8%]; no HT group, 129 [0.7%]). Multivariable Cox proportional hazards analysis showed that the second-generation AA group had an increased risk of depression compared with the no HT group (hazard ratio [HR], 2.15; 95% CI, 1.79-2.59; P < .001) and the traditional HT group (HR, 2.26; 95% CI, 1.88-2.73; P < .001), including specifically among those with metastatic disease at diagnosis (HR, 2.40; 95% CI, 1.38-4.15; P = .002). CONCLUSIONS AND RELEVANCE In this cohort study, patients with prostate cancer who received a second-generation AA had a large and clinically significant increased risk of depression compared with patients who received traditional HT alone or no HT, including when limiting our analysis to individuals with metastatic disease at diagnosis.
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Affiliation(s)
| | - Xiudong Lei
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Mackenzie R. Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
| | - Paul G. Corn
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Sharon H. Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kevin T. Nead
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston
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7
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Wallis CJD, Malone S, Cagiannos I, Morgan SC, Hamilton RJ, Basappa NS, Ferrario C, Gotto GT, Fernandes R, Niazi T, Noonan KL, Saad F, Hotte SJ, Hew H, Chan KY, Wyllie LP, Shayegan B. Real-World Use of Androgen-Deprivation Therapy: Intensification Among Older Canadian Men With de Novo Metastatic Prostate Cancer. JNCI Cancer Spectr 2021; 5:pkab082. [PMID: 34926988 PMCID: PMC8678925 DOI: 10.1093/jncics/pkab082] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the wealth of evidence demonstrating the efficacy of treatment intensification beyond androgen-deprivation therapy (ADT) among patients with de novo metastatic castration-sensitive prostate cancer (mCSPC), little is known of its real-world use. This study examined the real-world uptake of ADT treatment intensification among older men in a large Canadian province. METHODS We performed a retrospective population-based cohort study using province-wide linked administrative data in Ontario, Canada. Patients 66 years of age and older with de novo mCSPC were included and their treatment with conventional ADT-based regimens, ADT plus next-generation androgen receptor axis-targeted therapy, and ADT plus docetaxel were identified and stratified by time. RESULTS From 2014 to 2019, 3556 patients were identified with de novo mCSPC. Most patients (n = 2794 [78.6%]) were treated with a conventional ADT regimen, whereas 399 (11.2%) patients received ADT intensification with docetaxel and 52 (1.5%) patients received abiraterone acetate plus prednisone. In a time-stratified analysis of ADT intensification before and after the pivotal AA+P trial (LATITUDE), AA+P uptake increased from 0.5% to 3.0%, whereas docetaxel use dropped from 12.0% to 10.0%. The median survival of the study population was 18 months (interquartile range = 10-31). CONCLUSIONS The majority of patients with de novo mCSPC are treated with ADT alone in the Canadian real-world setting, despite randomized clinical trial evidence of benefit with the use of ADT-intensified regimens. As ADT treatment intensification is substantially underused, better understanding of the barriers to treatment and targeted education to address them are needed.
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Affiliation(s)
- Christopher J D Wallis
- Department of Urologic Surgery, Vanderbilt
University Medical Center, Nashville, TN, USA
- Correspondence to: Christopher J. D. Wallis,
MD, PhD, FRCSC, Department of Urologic Surgery, Vanderbilt University Medical
Center, A1302 Medical Center North, Nashville, TN 37232-2765 USA (e-mail:
)
| | - Shawn Malone
- Division of Radiation Oncology, The Ottawa Hospital,
University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, The Ottawa Hospital, University
of Ottawa, Ottawa, ON, Canada
| | - Scott C Morgan
- Division of Radiation Oncology, The Ottawa Hospital,
University of Ottawa, Ottawa, ON, Canada
| | - Robert J Hamilton
- Department of Surgery, University of Toronto,
Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, Cross Cancer Institute,
University of Alberta, Edmonton, AB, Canada
| | - Cristiano Ferrario
- Department of Oncology, McGill University, Segal
Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Geoffrey T Gotto
- Department of Surgery, Southern Alberta Institute of
Urology, University of Calgary, Calgary, AB, Canada
| | - Ricardo Fernandes
- Division of Medical Oncology, London Regional Cancer
Program, London, ON, Canada
| | - Tamim Niazi
- Radiation Oncology Department, Jewish General
Hospital, McGill University, Montreal, QC, Canada
| | - Krista L Noonan
- BC Cancer Agency, University of British
Columbia, Surrey, BC, Canada
| | - Fred Saad
- Genitourinary Oncology, Centre Hospitalier de
l’Université de Montréal, University of
Montreal, Montréal, QC, Canada
| | - Sebastien J Hotte
- Department of Oncology, McMaster University,
Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Huong Hew
- Medical Affairs, Janssen Inc,
Toronto, ON, Canada
| | | | | | - Bobby Shayegan
- Institute of Urology, St Joseph’s
Healthcare, McMaster University, Hamilton, ON, Canada
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Alibhai SMH, Breunis H, Feng G, Timilshina N, Hansen A, Warde P, Gregg R, Joshua A, Fleshner N, Tomlinson G, Emmenegger U. Association of Chemotherapy, Enzalutamide, Abiraterone, and Radium 223 With Cognitive Function in Older Men With Metastatic Castration-Resistant Prostate Cancer. JAMA Netw Open 2021; 4:e2114694. [PMID: 34213559 PMCID: PMC8254132 DOI: 10.1001/jamanetworkopen.2021.14694] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Older adults are at greater risk of cognitive decline with various oncologic therapies. Some commonly used therapies for advanced prostate cancer, such as enzalutamide, have been linked to cognitive impairment, but published data are scarce, come from single-group studies, or focus on self-reported cognition. OBJECTIVE To longitudinally examine the association between cognitive function and docetaxel (chemotherapy), abiraterone, enzalutamide, and radium Ra 223 dichloride (radium 223) in older men with metastatic castration-resistant prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A multicenter, prospective, observational cohort study was conducted across 4 academic cancer centers in Ontario, Canada. A consecutive sample of 155 men age 65 years or older with metastatic castration-resistant prostate cancer starting any treatment with docetaxel, abiraterone acetate, enzalutamide, or radium Ra 223 dichloride (radium 223) were enrolled between July 1, 2015, and December 31, 2019. EXPOSURES First-line chemotherapy (docetaxel), abiraterone, enzalutamide, or radium 223. MAIN OUTCOMES AND MEASURES Cognitive function was measured at baseline and end of treatment using the Montreal Cognitive Assessment, the Trail Making Test part A, and the Trail Making Test part B to assess global cognition, attention, and executive function, respectively. Absolute changes in scores over time were analyzed using univariate and multivariable linear regression, and the percentages of individuals with a decline of 1.5 SDs in each domain were calculated. RESULTS A total of 155 men starting treatment with docetaxel (n = 51) (mean [SD] age, 73.5 [6.2] years; 34 [66.7%] with some postsecondary education), abiraterone (n = 29) (mean [SD] age, 76.2 [7.2] years; 18 [62.1%] with some postsecondary education), enzalutamide (n = 54) (mean [SD] age, 75.7 [7.4] years; 33 [61.1%] with some postsecondary education), and radium 223 (n = 21) (mean [SD] age, 76.4 [7.2] years; 17 [81.0%] with some postsecondary education) were included. Most patients had stable cognition or slight improvements during treatment. A cognitive decline of 1.5 SDs or more was observed in 0% to 6.5% of patients on each measure of cognitive function (eg, 3 of 46 patients [6.5%; 95% CI, 2.2%-17.5%] in the group receiving chemotherapy [docetaxel] had a decline of 1.5 SDs for Trails A and Trails B). Although patients taking enzalutamide had numerically larger declines than those taking abiraterone, differences were small and clinically unimportant. CONCLUSIONS AND RELEVANCE These findings suggest that most older men do not experience significant cognitive decline in attention, executive function, and global cognition while undergoing treatment for advanced prostate cancer regardless of the treatment used.
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Affiliation(s)
| | - Henriette Breunis
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- Radiation Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Richard Gregg
- Department of Medical Oncology, Kingston Regional Cancer Centre, Kingston, Ontario, Canada
| | - Anthony Joshua
- Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - Neil Fleshner
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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