Patients with cardiovascular disease or diabetes have longer survival when treated with enzalutamide vs abiraterone for metastatic castration-resistant prostate cancer (mCRPC), according to research published in Prostate Cancer and Prostatic Diseases.

In a retrospective study of 5822 veterans treated for mCRPC during 2014-2017, 43% initially received enzalutamide, and 57% initially received abiraterone. After androgen axis targeted treatment, 52.4% of veterans received subsequent therapies.

Overall, veterans receiving enzalutamide first had significantly longer median overall survival (OS) compared with veterans receiving abiraterone first — 24.2 months and 22.1 months, respectively. There was a survival benefit among men aged 75 years and older (21.2 months vs 18.4 months) and those with a Charlson Comorbidity Index of 4 or more vs less than 4 (21.5 months vs 18.2 months).

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Among the 5822 veterans, 4207 had cardiovascular disease or diabetes. In this subgroup, the median treatment duration was significantly longer with enzalutamide than abiraterone (11.4 months vs 8.6 months), as was median OS (23.2 months vs 20.5 months).

After propensity score matching by age and cardiac comorbidities, enzalutamide was significantly associated with a 10% decreased mortality risk compared with abiraterone.

Men who started with enzalutamide vs abiraterone were older (mean age, 75.8 years vs 75.0 years), had a higher mean Charlson comorbidity index (4.4 vs 4.1), and had higher rates of cardiovascular disease or diabetes (74.2% vs 70.6%).

“By focusing on patients who are older and/or who have comorbid illnesses, our analyses give potentially actionable information from real-world data to guide treatment decisions,” the researchers wrote.


Schoen MW, Carson KR, Eisen SA, et al. Survival of veterans treated with enzalutamide and abiraterone for metastatic castrate resistant prostate cancer based on comorbid diseases. Prostate Cancer Prostatic Dis. Published online September 14, 2022. doi:10.1038/s41391-022-00588-5

This article originally appeared on Renal and Urology News