Final LATITUDE Data Confirm Abiraterone's Long-term OS Benefits for High-Risk, Hormone-Naive, Metastatic Prostate Cancer

Gerald Chodak, MD


April 02, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Gerald Chodak for Medscape. Today's commentary is based on a study presented at the recent Genitourinary Cancers Symposium in February.

This is the final analysis of a large, randomized trial that evaluated the impact of abiraterone acetate plus prednisone in combination with androgen deprivation therapy, and it was compared with androgen deprivation therapy plus placebo.[1]

The patients who were enrolled had newly diagnosed, high-risk, hormone-naive, metastatic prostate cancer. High risk consisted of men having at least three lesions on bone scan, Gleason score > 7, or evidence of visceral metastases from CT or MRI, but that did not include lymph node metastases.

The analysis looked at overall survival plus secondary endpoints and has shown a very highly significant improvement in overall survival in the men receiving abiraterone plus prednisone.

The median survival was 53.3 months in the abiraterone group compared with 36.5 months in the group receiving the placebo. Secondary endpoints were also achieved. This translated into a hazard ratio of 0.7, meaning it was about a 30% reduction in overall mortality.

There were significantly more side effects in the men receiving the abiraterone, including hepatotoxicity, hypokalemia, and hypertension, and those were grade 3/4 combined. Nevertheless, the overall benefit is quite clear.

The concept of combining androgen blockade was first developed about 20 years ago, in which patients received androgen deprivation therapy with a first-generation antiandrogen. There was quite a bit of controversy at that time because only a few of the studies did show a benefit while most of them did not.

A few years later, the antiandrogen withdrawal phenomenon [came to light], which partially would have explained why many of those studies were not successful. However, now we have proof of concept with a more potent antiandrogen in abiraterone acetate for men who have high-risk, hormone-naive, metastatic disease. This should be the standard of care for all men going forward.

I look forward to your comments. Thank you.

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