Influence of abiraterone and enzalutamide on body composition in patients with metastatic castration resistant prostate cancer

Cancer Treat Res Commun. 2020:25:100256. doi: 10.1016/j.ctarc.2020.100256. Epub 2020 Dec 1.

Abstract

Introduction: Loss of skeletal muscle (SM) and gain of subcutaneous fat (SCF) are known side-effects of androgen-deprivation in treatment of prostate cancer. Scarce data is available concerning the effects of abiraterone/pred (ABI) on body composition and no published data regarding enzalutamide (ENZA). Our objective was to analyse the effects of ENZA on SM/SCF and to compare the results with ABI in patients with metastatic castration-resistant prostate-cancer (mCRPC).

Patients and methods: 54 patients starting ABI (n = 17) or ENZA (n = 37) at a single-centre between 2012 and 2018 were retrospectively identified. SM and SCF were assessed using CT-scans at baseline and after a median of 10.8 months on treatment. A deep learning image-segmentation software was used to quantify SM and SCF. In a subgroup of patients receiving ENZA within a trial, we investigated change of SM using serial timepoints.

Results: Median time of treatment with ABI/ENZA was 14.6 months. A significant loss of SM compared to baseline was observed for ENZA (mean loss 5.2%, p<0.0001) and ABI (mean loss 3.0%, p = 0.02). SCF was not significantly altered. The effects of both drugs did not differ significantly. Loss of SM occurred early on during treatment with ENZA.

Conclusion: Treatment with ENZA seems to lead to a loss of SM which is comparable to that of ABI. Further evaluation in larger patient-cohorts is warranted. In routine care, counselling of patients about side effects of ABI/ENZA should include discussions about SM loss.

Keywords: Abiraterone; Enzalutamide; Muscle loss; Prostate cancer; Sarcopenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Androstenes / pharmacology
  • Androstenes / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Benzamides / pharmacology
  • Benzamides / therapeutic use*
  • Body Composition
  • Humans
  • Male
  • Neoplasm Metastasis
  • Nitriles / pharmacology
  • Nitriles / therapeutic use*
  • Phenylthiohydantoin / pharmacology
  • Phenylthiohydantoin / therapeutic use*
  • Prostatic Neoplasms, Castration-Resistant / drug therapy*

Substances

  • Androstenes
  • Benzamides
  • Nitriles
  • Phenylthiohydantoin
  • enzalutamide
  • abiraterone