Comparison of the cardiotoxicity of abiraterone and enzalutamide in metastatic castration-resistant prostate cancer using real-world data
Jason Hu1, Armen-G. Aprikian1,2,3, Marie Vanhuyse2,4, Alice Dragomir1.
1Urology, McGill University, Montreal, QC, Canada; 2Oncology, McGill University, Montreal, QC, Canada; 3Division of Urology, McGill University Health Centre, Montreal, QC, Canada; 4Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
Introduction: Novel hormonal agents (NHAs) such abiraterone acetate (ABI) and enzalutamide (ENZ) are frequently used in metastatic castration-resistant prostate cancer (mCRPC). Despite their overall tolerable risk profiles, some cardiotoxicity signals were reported for these agents in clinical trials but little is known about their incidence in clinical practice. The objective was to assess the comparative cardiovascular safety of ABI and ENZ in patients with mCRPC in the real-world.
Methods: A retrospective population-based cohort was extracted from Quebec public healthcare administrative databases. Patients were selected on the basis of having initiated an NHA (ABI or ENZ) between 2012 and 2016. The primary outcome of interest was cardiovascular-related hospitalization (composite outcome of acute coronary syndrome, cerebrovascular stroke, heart failure, arrhythmia and others). Inverse probability of treatment weighting (IPTW) with the propensity score was used to adjust for baseline characteristics.
Results: The cohort comprises 2,183 patients, with 1,773 (81.2%) in the ABI group and 410 (18.8%) in the ENZ group. Crude incidence rates of cardiovascular-related hospitalization were of 9.8 events per 100 person-years (PYs) and of 7.1 events per 100 PYs for the ABI and ENZ groups, respectively. After applying IPTW, the ABI group was at greater risk of cardiovascular-related hospitalization compared to the ENZ group (hazard ratio (HR) 1.82; 95% confidence interval (95%CI) 1.09-3.05). The risk of hospitalization for heart failure was greater in ABI (HR 2.88; 95%CI 1.09-7.63).
Conclusions: In our study population, there was a greater risk of cardiovascular-related hospitalizations for ABI users relative to ENZ users, in particular for hospitalization for heart failure. These results provide clinicians with additional insight on the cardiovascular risks of mCRPC patients treated with NHAs in the real-world and further large studies are required to corroborate these findings.
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