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ASCO GU 2024: Cognitive Function With Abiraterone vs Enzalutamide in Metastatic Prostate Cancer

By: Julia Fiederlein Cipriano, MS
Posted: Thursday, February 15, 2024

Patients with metastatic castration-resistant prostate cancer experience similar composite cognitive outcomes with abiraterone acetate vs enzalutamide, based on the results of the multicenter ACE study, which were presented during the 2024 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium (Abstract 20). However, according to Amit Bahl, MBBS, MD, of Bristol Haematology and Oncology Centre, United Kingdom, and colleagues, those who received enzalutamide reported more fatigue, depression, and deterioration in perceived cognitive ability and demonstrated slower reaction times.

Patients underwent the Cambridge Neuropsychological Test Automated Battery (CANTAB) assessment and completed the Functional Assessment of Cancer Therapy (FACT)–Cognitive Function, FACT–Fatigue, and Patient Health Questionnaire (PHQ-9) at baseline (n = 253), and 3 (n = 184), 4, and 6 (n = 131) months after initiating treatment.

The mean composite cognitive outcomes and individual components for Spatial Working Memory, Rapid Information Processing, and Spatial Information Processing did not appear to differ with either treatment; however, the Reaction Time Task difference was found to be significant at 3 and 6 months. Analysis of covariance testing revealed a significant widening of the gap between enzalutamide and abiraterone acetate at the 6-month mark; this seemed to be because of a marginal decline and improvement in the performance of the agents, respectively.

When comparing individual components of patient-reported outcomes between baseline and each timepoint, the investigators observed significant deterioration with enzalutamide, whereas the use of abiraterone acetate showed no such decline; the mean fatigue appeared to significantly differ between the treatments at 3 and 6 months. The mean PHQ-9 score for depression increased with both agents, with significantly poorer outcomes reported with enzalutamide at 3 and 6 months. At these timepoints, the mean perceived cognitive ability and comments from others were found to be significantly poorer with enzalutamide; perceived cognitive impairment did not seem to significantly differ between the treatments.

Disclosure: For full disclosures of the study authors, visit

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