BACKGROUND With 1.3 million new cases in 2018 worldwide, prostate cancer remains a challenge. Development of novel therapies targeting the androgen pathway followed recognition of the continued importance of androgens in castrate-resistant prostate cancer. To assess abiraterone and enzalutamide efficacy we analyzed data from US Veterans Administration Medical Centers (VAMCs). METHODS We used a novel method independent of assessment intervals and ideal for real-world analysis to estimate rates of tumor growth (g) and regression (d). FINDINGS Using the VA Informatics and Computing Infrastructure, we collected data from 5,116 Veterans with castrate-resistant prostate cancer prescribed abiraterone, enzalutamide or both. We estimated values for g and d and demonstrated a correlation of g with overall survival (P < .0001). Abiraterone and enzalutamide slowed growth rates across age groups and across the entire VAMC system, although less so in Veterans previously treated with a taxane and those with Gleason grade group 5 tumors. Abiraterone and enzalutamide efficacy in first-line were comparable although abiraterone in first-line slowed growth rates significantly more in African Americans than in Caucasians; enzalutamide was a better salvage therapy. When abiraterone was first-line and g was low, switching to enzalutamide was associated with a faster g in 67%. INTERPRETATION In the real-world g can be estimated using a novel analysis method indifferent to assessment intervals that correlates highly with OS. While we show excellent real-world outcomes with abiraterone and enzalutamide, 2 effective and tolerable therapies, our results in VAMCs suggest enzalutamide should follow abiraterone. Changing therapies may be detrimental and consideration should be given to continue monitoring of growth rates over time. Funding Support from the Prostate Cancer Foundation and the Blavatnik Family Foundation.

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一种评估在转移性前列腺癌中癌症治疗的现实效果的新颖方法。分析了使用阿比特龙和恩杂鲁胺治疗的退伍军人的国家数据。

背景技术在2018年全球有130万新病例的情况下，前列腺癌仍然是一个挑战。在针对雄激素途径的新型疗法的发展之后，人们认识到雄激素在去势抵抗性前列腺癌中的持续重要性。为了评估阿比特龙和恩杂鲁胺的疗效，我们分析了美国退伍军人管理局医学中心（VAMC）的数据。方法我们使用了一种新颖的方法，该方法独立于评估间隔，并且非常适合在现实世界中进行分析，以估计肿瘤的生长率（g）和消退率（d）。研究结果使用VA信息学和计算机基础设施，从5116名去势抵抗性前列腺癌处方阿比特龙，恩杂鲁胺或两者兼有的退伍军人中收集了数据。我们估计了g和d的值，并证明了g与总生存期的相关性（P <.0001）。阿比龙和恩杂鲁胺减慢了各个年龄段和整个VAMC系统的生长速度，尽管以前使用紫杉烷治疗的退伍军人和格里森5级肿瘤的退伍军人的生长速度减慢。一线的阿比特龙和enzalutamide疗效可比，尽管一线的阿比特龙减慢了非洲裔美国人的生长速度，比白种人高得多。恩杂鲁胺是一种较好的挽救疗法。当阿比特龙是一线药物且g较低时，改用enzalutamide可使g更快（67％）。解释在现实世界中，可以使用一种新颖的分析方法来估计g，而该方法无需考虑与OS高度相关的评估间隔。尽管我们显示阿比特龙和恩杂鲁胺在现实世界中具有出色的治疗效果，但2种有效且可耐受的疗法，我们在VAMC中的结果表明enzalutamide应该跟随阿比特龙。改变疗法可能是有害的，应考虑随着时间的推移继续监测增长率。前列腺癌基金会和Blavatnik家庭基金会的资金支持。