First-line treatment with abiraterone for metastatic castrate-resistant prostate cancer tied to better survival in Black vs White men
Dr. Ravi B. Parikh and his team, from the University of Pennsylvania Perelman School of Medicine,
reported that the overall survival disparity between Black and White men may be due to decreased benefits associated with abiraterone treatment in White men. Prior research suggests that abiraterone is associated with greater clinical benefits for Black patients than for White patients with metastatic castration-resistant prostate cancer (mCRPC), i.e., advanced-stage prostate cancer that no longer responds to hormonal therapy, a finding that this real-world cohort study affirms. Using data from a nationwide electronic health record database, investigators studied 3808 men who received first-line systemic therapy at approximately 800 sites across the US for mCRPC. The cohort included 2615 White and 404 Black men. At the time of diagnosis, the men had mean ages of 74 and 69 years, respectively.
The median overall survival was significantly longer for Black men than (non-Hispanic) White men (23 vs 17 months). The study reported that Black men have a significantly lower risk for death (24%) when compared to White men.
Among White men, those treated with first-line abiraterone had a significantly shorter median survival time compared with those who received first-line treatment with enzalutamide (17 vs 20 months). Among White men, first-line abiraterone treatment was significantly associated with a 21% increased risk of death compared with first-line treatment with enzalutamide. In contrast, the investigators found no racial difference in overall survival among patients receiving first-line enzalutamide. An acknowledged limitation of this study was the inability to account for socioeconomic factors and biases that could have contributed to the receipt of a given therapy and other disparities in treatment outcomes.
JAMA Netw Open. Published online January 5, 2022. doi:10.1001/jamanetworkopen.2021.42093