Cognitive Function Impact of Abiraterone Acetate, Enzalutamide on Patients With mCRPC

Both abiraterone acetate (AA) and enzalutamide are accepted treatments for metastatic castrate-resistant prostate cancer (mCRPC). However, increased research into the early effects of these treatments regarding cognitive function, fatigue, and depression would improve treatment selection and supportive care planning for patients.

A study conducted by Amit Bahl, MD, FRCP, FRCR, and colleagues investigated the effects of AA and enzalutamide on cognitive function and fatigue in patients with mCRPC.

Their research was presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium.

Researchers noted no difference in the mean composite cognitive outcome between the enzalutamide group and the AA group at both 3 (P=.553) and 6 months (P=.198). They also found no difference in spatial working memory, rapid information processing, or spatial information processing.

The enzalutamide group (P<.001) experienced a significant deterioration in mean fatigue changes when compared with the AA group. Investigators observed a significant difference in mean fatigue between AA cohort and the enzalutamide cohort at both 3 months (P<.001) and 6 months (P<001).

While both groups exhibited increased levels of depression, patients experienced significantly worse outcomes in the enzalutamide cohort at 3 months (P=.22) and 6 months (P=.020) than in the AA cohort.

Perceived cognitive ability and comments from others were also significantly poorer in the enzalutamide cohort at 3 months (P<.001) and 6 months (P<.001).

Dr. Bahl and colleagues concluded that overall cognitive outcome is similar in patients who received AA and enzalutamide at both 3 and 6 months. However, they noted that patients prescribed enzalutamide experienced increased fatigue, depression, and decline in perceived cognitive ability.

“This is an important consideration for treatment optimization and ensuring supportive strategies for the patients when using these drugs keeping in perspective the cognitive function assessment at baseline and subsequently on treatment,” the researchers wrote.