Effect of concomitant medications on treatment response and survival in non-metastatic castrate resistant prostate cancer: Exploratory analysis of the SPARTAN trial

• Published in: European journal of cancer (1990) 2024-11, Vol.211, p.114197, Article 114197
• Main Authors: Roy, Soumyajit, Saad, Fred, Sun, Yilun, Malone, Shawn, Spratt, Daniel E., Kishan, Amar U., Wallis, Christopher J.D., Jia, Angela Y., Mohamad, Osama, Swami, Umang, Ong, Michael, Agarwal, Neeraj, Chowdhury, Simon, Morgan, Scott C.
• Format: Article
• Language: English
• Subjects: Angiotensin-converting enzyme inhibitors; Apalutamide; Metformin; Non-metastatic castration-resistant prostate cancer; Statins
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2024.114197

We performed an exploratory analysis of the SPARTAN trial to determine whether concomitant exposure to several classes of commonly prescribed medications influenced the effect of apalutamide on overall survival (OS) and metastasis-free survival (MFS) in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). SPARTAN was a phase III randomized controlled trial in which nmCRPC patients were randomly assigned in a 2:1 ratio to receive androgen deprivation therapy with or without apalutamide. We focused on 5 commonly prescribed classes of medications: metformin, statins, angiotensin converting enzyme inhibitors (ACEI), acetylsalicylic acid (ASA), and proton pump inhibitors (PPI) based on a plausible biological and clinical rationale. To determine the potential effect modification, we applied multivariable Cox regression models for OS and MFS separately with additional interaction terms. To determine the independent association of concomitant medications with OS and MFS, we used IPTW-based log-rank test. A 2-sided p