Introduction: Recent advances made it possible to develop new systemic treatments for the management of metastatic castration-resistant prostate cancer (mCRPC). Of note, the introduction of the androgen receptor axis-target (ARAT) directed-drug abiraterone acetate (AA), plus prednisone, approved for first and second-line settings, changed the landscape of treatment, presenting new challenges and many questions for practicing uro-oncologists.
Aim: To report the experience with the introduction of abiraterone in the treatment of mCRPC patients (pts) in two general hospitals.
Material and Methods: Retrospective evaluation of the electronic medical records (EMR) of all pts treated with AA in two general hospitals of Lisbon, Portugal, from January 2007 to April 2017. Statistical analysis was performed with Stata v14.2, StataCorp, 2017.
Results: A total of 49 pts with mCRPC treated with AA were included, with a median age of 66.8 years-old (yo) [50.5; 90.2]. Forty-three (43) pts were at D’Amico high risk group at diagnosis. Thirty-one (31) pts received AA as first line therapy, with a median age of 69 yo, higher than the median for those who received AA in other lines (62.9 yo; p = 0,004). Time from diagnosis to castration resistant disease was 11.37 years [0.42; 20.42]. Median duration of treatment with AA was 7.63 months [0.7; 27.5], which was equivalent to time to progression. Median overall survival (OS) of the study population was 10 years [0,83; 21,8] since diagnosis, and 34.83 months [1; 81] since resistance to castration. The most common reason for discontinuing treatment was disease progression (n=30), although in 4 pts this interruption was motivated by drug-related adverse effects.
Conclusions: In our clinical practice, median time to progression was shorter than on COU-AA-301 and COU-AA-302 trials. Observed OS is in accordance with the literature. There seems to be a trend for the use of upfront abiraterone in older patients.
