Influence Of Statins On Survival Outcome In Patients With Metastatic Castration-Resistant Prostate Cancer Treated With Androgen Receptor Inhibitors

There is a little clinical data to the use of statins and new androgen receptor inhibitors (ARIs) in patients with mCRPC. Statins can enhance the effect of new ARIs in patients with mCRPC through a competitive interactions, decreasing the recruitment as an androgenic precursor. The aim of the study is to determine whether the use of statins with new ARIs has a clinical impact on survival in patients with mCRPC. Patients diagnosed of mCRPC and treated with new ARIs without previous chemotherapy were included. The patients were stratified by statins or non-statins. We described categorical and continuous variables in each group. Comparisons of survival rates were performed using log rank statistics. Multivariate analysis was performed with Cox regression modelling. Value of p < .05 was set as significant. The variables studied were: hemoglobin, lymphocytes, alkaline phosphatase, pain, use of opioids, type of ARIs, radiotherapy, androgen deprivation (AD), prostate-specific-antigen (PSA) at diagnosis, nadir PSA and statins and PSA response at 4, 8, 12, and16 weeks. Between April 2009 and August 2018, 64 patients (42 Abidaterone and 22 Enzalutamide) were included. The median survival of the entire cohort of patients was 40.8 months (95% CI 33.64 – 48.08). Overall survival (OS) was 43.2 months for the statin group (95% CI 36.98 – 49.41, p = 0.035) and 29.7 months for the non-statin group (95% CI 23.45 – 36.01). Progression-free survival (PFS) was 18 months for the statin group (95% CI 8.64 – 27.35, p = 0.004) and 7 months for the non-statin group (95% CI 4.60 – 9.39). No relationship was observed between statins and the lowering of PSA at 4, 8, 12 and 16 weeks compared to the non-statin group (P = ns). On multivariate analysis, factors associated to survival were LDH (HR 1,007, CI 95%, 1,002 – 1,013, p = 0.01), Neutrophils (HR 1,001, CI 95% 1,000 – 1,001, p = 0.049), and statins (HR 2,790, CI 95% 1,011 – 7,698, p = 0.045). In this retrospective cohort, the use of statins increases overall and progression-free survival compared to the use of ARIs without statins in mCRPC. Factors associated to survival were LDH, neutrophils, and statins. Statins do not modify the PSA response in the first 4 months of treatment.Abstract 2642; Table 1Patient characteristicsSTATINS (n = 32 ptes)Not STATINS (n = 32 ptes)pMedian age at diagnosis (range)69,8 years (46 – 85)67,9 years (43 – 86)0.415KPS <80 >8010 (31%) 22 (69%)10 (31%) 22 (69%)0.6Gleason score <7 8 - 1012 (37,5%) 20 (62,5%)15 (46,9%) 17 (53,1%)0.133Initial clinical stage Localized Metastatic13 (40,6%) 19 (59,4%)15 (46,9%) 17 (53,1%)0.614Time to CRPC months (range)62,5m (6 – 144m)59,09m (3 – 192m)0.755KPS at CRPC >80 <8015 (46,9%) 17 (53,1%)11 (34,4%) 21 (65,6%)0.309Alkaline phosphate (U/L)280 (58 – 452)365 (98 – 784)0.127LDH (U/L)338 (54 – 1074)552 (102 – 1990)0.019PSA (ng/ml)72,8 (1,14 – 368)96,7 (0,97 – 1006)0.503Type of AD Abiraterone Enzalutamide21 (65,6%) 11 (34,4%)21 (65,6%) 11 (34,4%)0.604 Open table in a new tab