Prostat kanserinde androjen reseptör yolu inhibitörlerinin uygulanabilirliği: komorbiditeler, yaş ve polifarmasinin etkisi-çok merkezli kohort çalışması

Abstract

Amaç: Bu çalışmada, prostat kanserinde androjen reseptör yolu inhibitörlerinin (ARPI) komorbidite ve polifarmasi varlığında uygulanabilirliği değerlendirildi. Yöntem: Yedi merkezden 538 hasta retrospektif olarak incelendi. Tedavi grupları ADT, ARPI ve kemoterapiye göre; ilaç kullanımı ?3 ve <3 olarak sınıflandırıldı. Bulgular: Hastaların ortalama yaşı 70,3 yıl olup %59,5’inde komorbidite, %34,4’ünde polifarmasi vardı. ARPI alanlarda sağkalım ADT grubuna göre daha uzundu. Polifarmasi grubunda takip süresi daha uzun ve mortalite daha düşüktü. Sonuç: ARPI’ler, yaşlı, komorbid ve polifarmasi hastalarında uygulanabilir ve etkilidir.

Aims: Androgen receptor pathway inhibitors (ARPIs) have improved outcomes in advanced prostate cancer. Still, evidence regarding their feasibility in older patients with comorbidities and multiple concomitant medications remains limited, as such populations are often underrepresented in clinical trials. Methods: This multicenter, retrospective cohort study included 538 prostate cancer patients diagnosed between January 2021 and November 2023 across seven centers in Turkiye. Demographic, clinical, pathological, and treatment data were extracted from institutional records. Patients were stratified by treatment type [androgen deprivation therapy (ADT), androgen receptor pathway inhibitor (ARPI), chemotherapy (CT)] and by the number of medications used (? three vs. <3). The primary outcome was overall survival (OS); secondary outcomes included follow-up duration, tumor grade, and metastatic distribution. Results: The mean age at diagnosis was 70.3 years, and 59.5% of patients had comorbidities. Concomitant medication use of three or more drugs, was observed in 34.4%. Metastatic disease was present in 82.3% of cases, most commonly involving the bone (62.8%). ARPI therapy was administered to 72.7% of patients, ADT alone to 18.6%, and CT to 8.7%. Patients receiving ARPIs had higher comorbidity and concomitant medication rates and more frequent metastases than those receiving ADT. Still, they achieved significantly longer median follow-up (901 vs. 470 days, p<0.001) and prolonged OS. Patients with concomitant medication use of three or more drugs also showed a longer follow-up (1081 vs. 573 days, p<0.001), lower mortality (32.4% vs. 47.3%, p=0.001), and a higher proportion of grade 1 tumors compared with patients using fewer than three medications. Conclusion: In this large real-world cohort, ARPIs were found to be feasible and effective, even in elderly, comorbid, and medication use of three or more patients, supporting their use beyond traditional trial populations.