A Real-World Study of PSA Response in Black and White Chemotherapy-Naive Prostate Cancer Patients Treated With Enzalutamide - Alicia Morgans

March 27, 2022

Oliver Sartor and Alicia Morgans discuss her recent presentation at GU ASCO 2022 on the results of a study assessing PSA outcomes in black and white chemotherapy-naïve prostate cancer patients treated with enzalutamide. This study assessed real-world PSA outcomes (response and progression) of enzalutamide-treated black vs white patients with prostate cancer patients in the US. Dr. Morgans and colleagues found a similar PSA response, however, black patients may have better clinical progression-free survival than white patients.  This study reinforces the effectiveness of enzalutamide for the treatment of chemotherapy-naïve patients with prostate cancer, irrespective of race
The outcomes of this study are consistent with other real-world studies that assessed treatment outcomes in black and white patients with prostate cancer treated with novel hormonal therapies.


A. Oliver Sartor, MD, Professor of Medicine and Medical Director, Tulane Cancer Center; C. E. and Bernadine Laborde Professor of Cancer Research, New Orleans, Louisiana

Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts

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Oliver Sartor: Hi, I'm Dr. Oliver Sartor. I'm Medical Director of the Tulane Cancer Center down in New Orleans, and really a pleasure to be here today with Alicia Morgans, GU Medical Oncologist at Dana-Farber. So, welcome, Alicia.

Alicia Morgans: Thank you so much, Dr. Sartor. It's such a pleasure to be here.

Oliver Sartor: We're going to interestingly discuss today, something I think that is a big issue, and that's some racial disparities, and how some studies indicate that they're favorable outcomes for those African Americans. And in particular, we're going to start talking about an enzalutamide study with metastatic castrate-resistant prostate cancer among African Americans and whites and how they did. I wonder if you might bring that to the front of our reader's attention and see what you might say.

Alicia Morgans: Well, thank you so much, Oliver. This is all spring-boarding on a poster that the team and I were able to present at GU ASCO 2022, where we looked at PSA outcomes among Black and white patients who were chemotherapy-naive, but had castration-resistant metastatic prostate cancer and received treatment with enzalutamide. We did this analysis as a real-world study in a urology data set, so really focused on patients who would be seen by the urologist and tried to understand, in this setting, how did patients respond? And really, the crux of this analysis was to see if there were differences in PSA response, whether that was PSA 50% response, whether it was PSA 75% response, and PSA 90% response.

What we found is that men treated with enzalutamide had similar PSA 50% responses and 75% responses, whether they were Black or white. But what was interesting is that there seemed to be a trend, at least. In addition, we also looked at clinical progression-free survival, and it appeared that, at least in our model, there was superior progression-free survival among African American or Black patients in this study, when we looked at the comparison between the groups. And in this model, at least, the hazard ratio was 0.82 and the p-value was 0.03, so it was statistically significant.

Oliver Sartor: This is a little reminiscent of what we call the abi Race study, which Dan George helped [inaudible] at Duke, as a multi-institutional study that was prospective. I wonder if you might comment about how these studies compare and contrast to the abi Race study because they're very, very similar.

Alicia Morgans: Absolutely. Abi Race, I think, was one of the most important studies in recent history to really look at this. And one of the reasons that I think it was so important is that it was a prospectively enrolled trial. There were 50 Black men and 50 white men in each arm and all received the same treatment, with the goal of really understanding not only the disease control outcomes, but also outcomes related to side effects. I think what was so interesting is that we saw that there maybe have been some slight differences in development of things like hypertension, with maybe more of the Black men in the study having higher rates of hypertension. And so it's not just, for my perspective, the disease control rates, which seems similar to perhaps better in the Black patients who are included in abi Race, it's also our understanding of how the drugs treat the individual from a side effect perspective. And any way that we can do this in a prospective manner and really collect that data in a modern and prospective manner, I think, is really important.

Now this, of course, is a real-world study. It is analysis done on data that we get from our clinical practice. So not nearly as detailed nor necessarily the level of data as abi Race, but certainly an attempt to show that with another approach for an AR-targeted agent, there's a similar benefit, if not more of a benefit in Black patients.

Oliver Sartor: Yeah. It's really interesting. I think we're all aware that African Americans have higher mortality from prostate cancer, but if you get the right treatment, it turns out, in the metastatic castrate-resistant setting, that the African Americans actually do quite well. We had a sickle cell T study that actually turned out to be, and it was an imperfect study because it was a registry of one to prospective trial, but nevertheless, the African Americans actually did better. And Susan Halby had a trial that showed that with docetaxel, people may have done better. And there's a radium trial that says African Americans may have done a little better. So it's really interesting to me that if you get the right treatments to the patients, that the disparities seem to diminish. Is that your take? Or how would you look at this data set as a whole?

Alicia Morgans: That is my take. And it's really such an impetus for us to go out and do our best for all patients and really to educate our patient community, that we have tools and they work on you and will work, at least as far as we know, on all patients. And if we can't treat you, we won't be able to make that difference. We won't be able to get that benefit. But patients seem to do well. They have disease control benefits, and they really can tolerate the treatment too. For all the treatments that you mentioned, tolerability was really, really good. So encouraging to me that if we can get the patients, the treatments that they need, we can help them.

Oliver Sartor: I think that's really important message. When you're sitting in a room with patients, I think it really helps to say, "Look, we now have some data to indicate that you're going to do pretty well in this study." And it turns out that the individual drugs may not even matter that much, but the ability to sit down and say, "You're going to do better and we have some data." I think that's a powerful message, actually.

Alicia Morgans: Absolutely. I think for anyone sitting in that chair, listening to their doctor talk about treatment, any encouragement, and certainly encouragement that's backed by data, is a welcomed thing.

Oliver Sartor: Good. Any other comments before we sign off?

Alicia Morgans: No. I just would say that I think it's up to us in our community to continue to study these disparities so that we can really drill down on what it is that is causing the difference is that we still see in our population-based analyses. We need to do better for all patients, and that starts with understanding these differences so that we can.

Oliver Sartor: Couldn't agree more, Alicia. Thank you for being here today. Always a pleasure.

Alicia Morgans: Always a pleasure for me too. Thank you so much.