Study findings reveal the use of abiraterone acetate plus prednisone for patients with metastatic prostate cancer resulted in less fatigue when compared to enzalutamide. However, this treatment also came with a higher incidence of type 2 diabetes.

In the first-line setting, both enzalutamide and abiraterone acetate plus prednisone have demonstrated similar efficacy for the treatment of patients with metastatic castration-resistant prostate cancer. This study aimed to discover fatigue, health-related quality-of-life, and metabolic changes in patients with metastatic castration-resistant prostate cancer treated with enzalutamide and abiraterone acetate plus prednisone.

In this phase 4 trial, 170 patients with metastatic prostate cancer that had progressed on androgen deprivation therapy were enrolled and randomized to either enzalutamide or abiraterone acetate plus prednisone. The primary outcome was the difference in fatigue from baseline, as determined by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. Secondary outcomes included the differences in changed health-related quality of life using the Functional Assessment of Cancer Therapy-Prostate questionnaire, body composition, weight, glucose homeostasis, lipid profile, and blood pressure. All outcomes were measured at baseline and at 12-week follow-up.

The researchers found a clinically meaningful difference in fatigue, favoring treatment with abiraterone acetate plus prednisone (3.4 points, 95% confidence interval, 1.2 to 5.6; P = .003). While the difference in quality-of-life also favored abiraterone acetate plus prednisone, it did not reach clinical significance.

In addition, patients treated with abiraterone acetate plus prednisone had a higher increase in glycated hemoglobin than those treated with enzalutamide. In the abiraterone acetate plus prednisone group, 8 patients developed type 2 diabetes, compared to no patients in the enzalutamide group.

Source:

Ternov K, Sønksen J, Fode M, et al. Fatigue, health-related quality-of-life and metabolic changes in men treated with enzalutamide or abiraterone acetate plus prednisone for metastatic castration-resistant prostrate cancer: A randomised clinical trial (HEAT). Eur J Cancer. Published online August 1, 2022. doi:10.1016/j.ejca.2022.04.034