Page 10 - CUA 2020_Sexual Dysfunction and Transplant

2020 CUA Abstracts

Results: A total of 7156 observations from 990 patients were identified UP-2.22
(7.2 measurements/patient, range 1–43) over a mean followup of 7.5 Population-based study of baseline bone density screening
years (4.3 years on ADT). Mean age at ADT initiation was 71 years. in prostate cancer patients treated with long-term androgen
PORPUS-P and PORPUS-U scores were 67.2±13.2 and 0.925±0.077 for deprivation therapy
patients starting oral ADT, 67.9±11.9 & 0.926±0.064 on gonadotropin- Jason Hu , Armen-G. Aprikian , Marie Vanhuyse , Alice Dragomir 1
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releasing hormone (GNRH) agonist/antagonist agents, and 60.5±11.1 & 1 Division of Urology, McGill University, Montreal, QC, Canada; Division
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0.891±0.070 for patients transitioning onto abiraterone/enzalutamide. of Medical Oncology, McGill University, Montreal, QC, Canada
After adjusting for age, income, rurality, marital status, comorbidity, Introduction: Androgen deprivation therapy (ADT) is a cornerstone of
local therapy, prostate-specific antigen (PSA), Gleason score and stage, advanced prostate cancer (PCa) treatment, however, it accelerates the loss
ADT therapy significantly decreased psychometric and utility scores (all of bone mineral density (BMD), which increases fracture risk. Guidelines
p<0.001): -3.3 and -0.015 with oral ADT, -5.0 and -0.023 on GNRH recommend BMD testing when initiating ADT to properly assess baseline
agents, and -11.0 and -0.055 after abi/enza. fracture risk. The objective was to examine the proportion of BMD testing
Conclusions: ADT is associated with a significant decrease in HRQoL in men initiating ADT in Quebec and to identify factors associated with
and was most pronounced following abi/enza. However, these effects the receipt of BMD testing.
are likely mediated by both the drug and disease process. These results Methods: The cohort consists of men extracted from Quebec public
represent the largest cohort of PRO in advanced prostate cancer, and will healthcare insurance administrative databases who initiated continuous
be critical to economic and policy model application. ADT from 2000–2015 for over 12 months. The primary study outcome
was the receipt of BMD testing in the period from six months prior to
UP-2.21 and up to 12 months after ADT initiation. Multivariable generalized linear
Outcomes of abiraterone plus prednisone vs. docetaxel in mixed regression modeling with a logit link was performed to identify
metastatic hormone-sensitive prostate cancer in a real-world variables associated with BMD testing.
setting Results: We identified 22 033 patients, of which 3910 (17.8%) underwent
Paulo Werlang , Tom Ying , Christopher Knee , Igal Kushnir , Christopher BMD testing. Rates of BMD testing increased from 4.1% in 2000 to 23.4%
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G. Morash , Rodney H. Breau , Luke T. Lavallée , Ilias Cagiannos 1 in 2015. Following multivariable analyses, prior history of osteoporosis (odds
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1 Urology, University of Ottawa, Ottawa, ON, Canada ratio [OR] 1.81; 95% confidence interval [CI] 1.29–2.52; p=0.001), rheuma-
Introduction: We compared outcomes of patients treated with docetaxel toid arthritis (OR 1.60; 95% CI 1.13–2.28; p=0.009), use of bisphosphonates
(DOC) or abiraterone + prednisone (AA+P) plus androgen deprivation (OR 1.46; 95% CI 1.25–1.72; p<0.001), and chronic corticosteroids (OR
therapy (ADT) in patients with metastatic hormone-sensitive prostate 1.60; 95% CI 1.13–2.27; p=0.008) were associated with higher odds of BMD
cancer (MHSPC) in a real-world setting. testing. Patient age >80 (OR 0.67; 95% CI 0.59–0.75; p<0.001), metastases
Methods: We conducted a retrospective chart review of patients treated (OR 0.79; 95% CI 0.70, 0.89; p<0.001), greater Charlson comorbidity score
with either DOC or AA+P at The Ottawa Hospital from January 1, 2014 to (OR 0.71; 95% CI 0.62–0.81; p<0.001), and rural residence (OR 0.77; 95%
April 1, 2017 (DOC group), and from January 1, 2017 to March 14, 2019 CI 0.67–0.87; p<0.001) were associated with lower odds of BMD testing.
(AA+P group). We included patients with hormone-sensitive disease who Conclusions: In our study population, BMD testing rates in men initiating
received ADT for the first time. The primary outcome was overall survival ADT were low, although they increased over the years. Potential gaps
(OS) rate. Secondary outcomes included radiological progression-free identified include the older, more comorbid, and rural areas. Overall,
survival (rPFS) and prostate-specific antigen (PSA) progression-free survival additional efforts emphasizing the importance of BMD testing in PCa
(pPFS). We also identified factors associated with survival. guidelines may be needed.
Results: We identified 102 eligible patients with MHSPC treated with
DOC or AA+P. Mean age was 66 years in the DOC group and 72 years UP-2.23
in the AA+P group (p<0.05). The median PSA at diagnosis in the DOC Population-based study of abiraterone and enzalutamide in the
group was 175, and 151 in AA+P group (p=0.3). Most patients in both post-chemotherapy setting in metastatic castration-resistant
groups had Gleason ≥8 (DOC 95%, AA+P 86%). The mean followup in prostate cancer
the DOC group was 26 months and in the AA+P group was 15 months Jason Hu , Armen G. Aprikian , Marie Vanhuyse , Soukaina Ouizzane ,
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(p<0.05). For the DOC group, nadir PSA levels six months post-initiation Alice Dragomir 1
of ADT were <0.2, 0.2–1, 1–4, and >4 ng/mL in 18%, 35%, 15%, and 1 Division of Urology, McGill University, Montreal, QC, Canada; Division
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32%, respectively. For the AA+P group, nadir PSA levels six months post- of Medical Oncology, McGill University, Montreal, QC, Canada
initiation of ADT were <0.2, 0.2–1, 1–4, and >4 ng/mL in 38%, 19%, Introduction: Novel hormonal agents, such abiraterone (ABI) and enzalu-
15%, and 28%, respectively. Patients receiving abiraterone had superior tamide (ENZA), have both demonstrated survival benefits in the post-
pPFS (p=0.0117). rPFS was not statistically different (p=0.3634). The only chemotherapy setting in metastatic castration-resistant prostate cancer
predictor of pPFS and rPFS was PSA six months post-initiation of ADT. (mCRPC). However, there are currently no randomized head-to-head
Patients with PSA >4 vs. <0.2, and PSA >1–4 vs. <0.2 had increasingly comparisons of both agents. The objective was to compare the effective-
greater results of failure. ness of ABI and ENZA as second-line treatments in the post-chemotherapy
OS did not differ significantly between groups (p=0.16). The only predictor setting in patients with mCRPC.
of OS was the PSA at six months >4 vs. <0.2 hazard ratio 13.85 (95% Methods: A retrospective, population-based cohort was extracted from
confidence interval [CI] 1.06–179.73). Quebec public healthcare administrative databases. Patients were selected
Conclusions: In our cohort study, DOC and AA+P groups had comparable based on having sequentially received androgen deprivation therapy and
survival endpoints. PSA nadir six months post-initiation of ADT appears chemotherapy prior to initiating a novel hormonal agent (ABI or ENZA)
to be an important predictor of OS, pPFS, and rPFS. Patients who failed between 2012 and 2016. The index date corresponded to the date of the
to reach PSA <1 had worse rPFS and pPFS. Patients who did not reach first prescription of ABI or ENZA. The primary outcome of interest was
PSA <4 had a poor OS rate. overall survival and evaluated with Kaplan-Meier analysis and multivari-
able Cox proportional hazards regression.
Results: The cohort is comprised of 621 patients, with 542 in the ABI
group and 79 in the ENZA group. Median age at initiation was similar
(ABI: 73, ENZA: 74; p=0.449). There were more patients in the ABI group
with a time from last chemotherapy to index date <6 months (ABI: 72.5%,
ENZA: 57.0%; p=0.005). Median duration of treatment was similar in both
groups at six months (interquartile range [IQR] 3–12) (p=0.317). Median
overall survival was 15.4 months in the ABI group and 17.9 months in
S66 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)