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

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.

Keywords: abiraterone acetate; metastatic castration-resistant prostate cancer; prospective study; real-world evidence.

Figure 1

Clinical effectiveness of abiraterone acetate plus prednisone for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) naive to chemotherapy. Radiographic progression-free survival^a (rPFS) (A), PFS^a (B), and overall survival (OS) (C) in the ABItude study. CI, confidence interval; NE, not estimable. ^aDuring abiraterone treatment.

Figure 2

Quality of life for abiraterone acetate plus prednisone. Median (IQR) FACT-P total (A), EQ-5D-3L (B), and EQ VAS scores (C) during treatment with abiraterone. EQ VAS, European Quality of Life Visual Analog Scale; EQ-5D-3L, European Quality of Life 5 Dimensions 3 Level; FACT-P, Functional Assessment of Cancer Therapy—Prostate; IQR, interquartile range.

Figure 3

Time to pain progression during abiraterone treatment.