MACE risk following ADT initiation was higher for older patients compared with younger patients. All comparisons were significant with a P value of < 0.05.
FCS medical oncologist Dr. Lucio Gordan is the lead investigator of this study utilizing data from more than 44,000 patients which demonstrate that the overall risk of major adverse cardiovascular events (MACE) is low in men with prostate cancer treated with androgen deprivation therapy (ADT).
The risk of major adverse cardiovascular events (MACE) following the initiation of androgen deprivation therapy (ADT) in men with prostate cancer is higher for older men compared with their younger counterparts. However, the overall MACE risk at 1 year in all age groups starting ADT is 1% or less, which is much lower than previously published reports. The findings, gleaned from analyses of U.S. electronic medical records, were presented during the virtual National Comprehensive Cancer Network 2022 Annual Meeting.
10-year metastasis-free survival was 71.9% in the short-course ADT group (6 months) and 78% in the long-course ADT group (24 months). So, it seems the longer the duration, the better the outcome. 93% had a Gleason score of 7 or higher.
We know that combination PARP and antiandrogen is better than antiandrogen alone. I have wondered if we need antiancrogen on those patients. This shows that, YES, we do. The combination also was better than PARP inhibitor monotherapy in those patients carrying HRRm.
It might be costly to get the PET scans but helps with prognosis and directing patients to palliative care since positive lesions in all predicts shorter overall survival.
The role for immunotherapy in combination with multitargeted therapy in prostate cancer, for patients who had previous docetaxol, or had visceral disease (liver) showed more benefit from the combination vs. second novel hormonal therapy. Recall that patients who had exposure to docetaxol can be treated with pluvicto. Genomic and genetic testing is encouraged for those patients as PARP targeted mutations can be found (homologous recombination-repair mutations).
SBRT improves PFS in addition to antiandrogen therapy. The question is, with oligomets, do we need systemic therapy in all patients? Or will SBRT be sufficient?
I encourage our FCS radiation oncologists to provide their input on this study, as well.
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1 thought on “Low Risk of Cardiovascular Events With ADT for Prostate Cancer; Higher Risk in Older Men”
A large retrospective VA study presented at ASCO 2020 reported increased MACE and more so with Agonists than antagonists. So I am skeptical about this EMR review data and it dose not differentiate Agonist vs antagonist; For patients with pre-existing or high risk I choose direct antagonists than agonists. Also to be noted there are increasing data that Abiratarone is associated with increase cardiovascular events.