Abiraterone acetate or enzalutamide treatment for metastatic castration-resistant prostate cancer (mCRPC) in chemotherapy-naive patients is associated with better overall survival (OS) in African American men compared with white men, investigators reported at the 2019 Genitourinary Cancers Symposium.


The study provides the first evidence that African American men with mCRPC have better OS than white men treated with either abiraterone acetate or enzalutamide, according to a team led by Megan Ann McNamara, MD, of Duke University School of Medicine in Durham, North Carolina.


In a retrospective study of 2123 white men and 787 black men with mCRPC, Dr McNamara and her colleagues found that the median OS time was 30 months for African Americans compared with 26 months for whites. African Americans had a significant, 17.4% decreased risk of death compared with whites, after adjusting for age and comorbidities (hazard ratio [HR]=0.826; 95% CI [0.732-0.933]; P =.0020).


“When controlling for access to care through a single-payer system, in this case the VA health system, in chemotherapy-naive metastatic castration-resistant prostate cancer patients, African Americans may have better overall survival than Caucasians when treated with abiraterone acetate or enzalutamide,” Dr McNamara said.


The findings reinforce what is already the standard of care, she said. “It's important that we have real-world studies that show that the standard-of-care treatments really work,” Dr McNamara said. “I don't think they necessarily change what we're doing, but they reinforce what we are already doing.”


The mean ages of the white and African American men were 74 and 71 years, respectively. The median follow-up time was 561 days and 570 days for whites and African Americans, respectively.


African American men were more likely than white men to have type 2 diabetes (38.1% vs 29.3%; P <.0001), hypertension (77.1% vs 67.1%; P <.0001), and liver damage or abnormality (8.8% vs 5.2%; P =.0003)