First-line abiraterone treatment for metastatic castration-resistant prostate cancer (mCRPC) is associated with greater survival in Black men compared with White men, according to a recent real-world cohort study.

Among men receiving first-line abiraterone, median overall survival was significantly longer for Black men than non-Hispanic White men (23 vs 17 months) in a propensity score-adjusted analysis, a team led by Ravi B. Parikh, MD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, reported in JAMA Network Open. Black men had a significant 24% lower risk for death compared with White men.

Using data from a nationwide electronic health record-derived database, the investigators studied 3808 men who received first-line systemic therapy for mCRPC. The men received treatment at approximately 800 sites of care across the US. The cohort included 2615 White and 404 Black men. At diagnosis, the men had mean ages of 74 years and 69 years, respectively.

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Among White men, those treated with first-line abiraterone had a significantly shorter median survival time compared with those who received first-line enzalutamide (17 vs 20 months). First-line abiraterone was significantly associated with a 21% increased risk for death compared with first-line enzalutamide, according to the investigators. They found no racial difference in overall survival among patients receiving first-line enzalutamide.

Dr Parikh and colleagues said the overall survival disparity between Black and White men may be due to decreased benefit associated with abiraterone among White men.

“Prior research suggests that abiraterone is associated with greater clinical benefit for African Americana patients than for White patients with mCRPC,” the authors noted. “This real-world cohort study affirms these findings and is, to our knowledge, the first one to find that first-line abiraterone was associated with improved overall survival among African American patients compared with White patients.”

As the study was a real-world analysis, the investigators noted, “a key limitation was the inability to fully account for socioeconomic factors and biases that, in conjunction with race, contribute to receipt of a given therapy and outcomes disparities.”


Marar M, Long Q, Mamtani R, et al. Outcomes among African American and non-Hispanic white men with metastatic castration-resistant prostate cancer with first-line abiraterone. JAMA Netw Open. Published online January 5, 2022. doi:10.1001/jamanetworkopen.2021.42093