Evaluation of the Effects of Enzalutamide and Abiraterone Acetate on Sarcopenia in Metastatic

Abstract

Sarcopenia is recognized as a significant negative prognostic factor, associated with increased mortality in a variety of solid tumors. Its management becomes particularly important in cancers predominantly affecting older adults, such as prostate cancer. This study aims to assess the impact of enzalutamide and abiraterone acetate on sarcopenia in patients with metastatic castration-sensitive prostate cancer (mCSPC). Background: Sarcopenia is associated with worse prognosis and higher mortality in various solid tumors. We aim to evaluate the impact of enzalutamide and abiraterone acetate on sarcopenia in patients with metastatic castration-sensitive prostate cancer. Materials and Methods: The skeletal muscle indexes (SMI, cm2/m2) were calculated from pre-treatment and 12th-month CT scans. Patients were categorized into sarcopenic and non-sarcopenic groups based on the predefined SMI and body mass index cut-off values. Baseline and 12th-month SMI values together with percentages of sarcopenic patients were compared between the enzalutamide and abiraterone acetate groups. Radiological progression-free survival (rPFS) and overall survival (OS) were also compared between sarcopenic and non-sarcopenic patients. Results: We included 19 patients receiving enzalutamide and 30 patients receiving abiraterone acetate. In the enzalutamide group, SMI decreased significantly from pre-treatment to the 12th month (median ASMI: -3.1 cm(2) /m(2) , P = .004). In the abiraterone acetate group, SMI declined significantly over the same period (median ASMI: -4.1 cm(2) /m(2) , P = .001). There were no significant differences in SMI changes and sarcopenia rates between two groups. Median rPFS was 29 months in the pre-treatment sarcopenic group and 37 months in the non-sarcopenic group (HR = 2.38 [95% CI, 0.54-10.41], P = .24). Median OS was 33 months in the sarcopenic group and 47 months in the non-sarcopenic group (HR = 1.94 [95% CI, 0.42-9.03], P = .38). Conclusion: Both enzalutamide and abiraterone acetate significantly reduces SMI values following a 12-month treatment period. Despite a trend toward shorter rPFS and OS in sarcopenic patients, the differences did not reach statistical significance.