St. LOUIS — How do prescription medications affect overall survival in metastatic hormone-sensitive prostate cancer?
That was a question addressed in a new study from the Saint Louis University School of Medicine, the St. Louis VAMC and Washington University in St. Louis.
“With new therapies for metastatic prostate cancer, patients are living longer, increasing the need for better understanding of the impact of comorbid disease,” the researchers wrote in Anticancer Research. “Prescription medications may risk-stratify patients independent of established methods, such as the Charlson Comorbidity Index (CCI) and guide treatment selection.”
The study team conducted a nationwide retrospective study of U.S. veterans to evaluate the association between number and class of prescription medications and overall survival (OS) with age, race, body-mass index, prostate specific antigen (PSA) and Charlson comorbidities as covariates. The focus was on veterans treated for de novo metastatic hormone sensitive prostate cancer (mHSPC) between 2010-2021.
The results indicated that, among 8,434 veterans, a median of nine medications and five medication classes were filled in the year prior to initial treatment with abiraterone or enzalutamide for mHSPC. The researchers reported that veterans on 1–4 medications had an average survival of 38 months compared to 5–9 medicines (33 months), 10–14 medicines (27 months) and 15+ medicines (22 months) (p<0.001).
“After adjusting for age, race, body mass index (BMI), PSA, CCI, and year of diagnosis, both the number of medications and medication classes were associated with increased mortality,” the authors advised.
The study pointed out that the adjusted hazard ratio (aHR) [95% confidence interval (CI)] was 1.03 (1.02-1.03) for the number of medications and 1.05 (1.04-1.07) for medication classes. Medications within ATC B (blood/blood forming organs), ATC C (cardiovascular) and ATC N (nervous system) were associated with worse OS, with aHRs of 1.14 (1.07, 1.21), 1.14 (1.06, 1.22) and 1.12 (1.06, 1.19), respectively, according to the report.
“The number and class of medications were independently associated with overall survival in patients undergoing treatment for mHSPC,” the researchers wrote. “With new therapies for advanced prostate cancer, patients are living longer, highlighting the need for a better understanding of the impact of comorbid diseases. Simple methods to assess disease burden and prognosticate survival have the potential to guide treatment decisions.”
- Pickett C, Karunanandaa K, Stackable K, Eaton DB Jr, Tohmasi S, Gopukumar D, Puri V, Schoen MW. Prescription Medications and Overall Survival in Metastatic Hormone Sensitive Prostate Cancer. Anticancer Res. 2024 Aug;44(8):3443-3449. doi: 10.21873/anticanres.17164. PMID: 39060059.