Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, 2 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 3 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
6 days ago
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.

Pre-existing CVD tied to increased mortality risk in men treated with abiraterone acetate

Roshini Claire Anthony
24 Apr 2019

Men with advanced prostate cancer who have pre-existing cardiovascular disease (CVD) may have an elevated mortality risk after treatment with abiraterone acetate compared with men who do not have CVD, according to a study presented at AACR 2019.

Using data from the Surveillance, Epidemiology, and End Result (SEER) database, researchers identified 2,845 men with advanced prostate cancer who were treated with abiraterone acetate between 2011 and 2014 (median age, 75 years). Of these, 67.6 percent (n=1,924) had at least one pre-existing cardiovascular condition (ie, acute myocardial infarction [MI], atrial fibrillation [AF], congestive heart failure [CHF], stroke, or ischaemic heart disease).

In the 6 months following initiation of abiraterone acetate therapy, the all-cause mortality rate was 15.9 percent among those without pre-existing CVD. In contrast, men with existing cardiovascular conditions had an elevated risk of mortality after starting treatment with abiraterone acetate (21.4 percent for those with ischaemic heart disease, 22.1 percent for those with stroke, 23.4 percent for those with CHF, 24.2 percent for those with AF, and 25.6 percent for those with acute MI. [AACR 2019, abstract 4469]

All patients had an elevated risk of hospitalization 6 months after initiating abiraterone acetate therapy, regardless of their pre-existing CVD status (incident rate ratio [IRR], 1.43, 95 percent confidence interval [CI], 1.30–1.57 [no CVD], IRR, 1.22, 95 percent CI, 1.01–1.48 [ischaemic heart disease], IRR, 1.27, 95 percent CI, 1.09–1.48 [AF], IRR, 1.30, 95 percent CI, 1.07–1.57 [stroke], IRR, 1.35, 95 percent CI, 1.21–1.51 [CHF], and IRR, 1.44, 95 percent CI, 1.12–1.86 [acute MI]).

The hospitalization risk was further increased among patients who did not receive chemotherapy and received abiraterone acetate at an earlier stage of disease (IRR, 1.53 [no CVD], IRR, 1.5 [ischaemic heart disease], IRR, 1.34 [AF], IRR, 1.52 [stroke], IRR, 1.48 [CHF], and IRR, 1.55 [acute MI]).

“Our data show that patients who have pre-existing CVD experienced higher mortality after receiving abiraterone acetate compared with those who do not, and the bulk of the survival differences occurred in the first 6 months [with little difference in survival after 6 months],” said study investigator Professor Grace Lu-Yao, Associate Director of Population Science at the Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, US.

“The increased post-treatment hospitalization rate shows that there is risk associated with abiraterone acetate for all patients. Abiraterone acetate use without prior chemotherapy was associated with a 34 to 55 percent increase in post-treatment hospitalization rate [among those with pre-existing CVD],” she added.

“Our study highlights the importance of carefully monitoring patients after prescribing abiraterone acetate,” she said.

“Patients with a history of significant CVD or uncontrolled hypertension are almost always excluded from clinical trials of abiraterone acetate. A substantial portion of patients treated in the real world do not quality for trial eligibility,” said Lu-Yao, highlighting that these conditions are common in men with prostate cancer. As such, it would be beneficial for men with these conditions to be included in clinical trials so as to be more representative of a real-world setting, she suggested.

“It is very important that patients with advanced prostate cancer understand that the outcomes of abiraterone acetate treatment observed in clinical trials may not apply to patients in the real world, especially those not meeting the eligibility criteria of the clinical trials,” she said.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, 2 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 3 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
6 days ago
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.