1632P Impact of androgen pathway inhibitors on cognitive function in elderly patients with metastatic prostate cancer: Results from the COG-PRO trial

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Boué, A. | Baciarello, G. | Meyer, E. | Christy, F. | Allouache, N. | Ratta, R. | Brachet, P-E. | Guerdoux, E. | Darlix, A. | Boone, Mathieu | Gouerant, S. | Leconte, A. | Lequesne, J. | Clarisse, B. | Fizazi, K. | Lange, M. | Joly Lobbedez, F.

Edité par CCSD ; Elsevier -

International audience. BackgroundAndrogen deprivation therapy (ADT) for metastatic prostate cancer (mPC) adversely impacts cognitive performance (objective cognition, OC) and increases perceived cognitive impairment (subjective cognition, SC). Androgen pathway inhibitors (ARPI) are commonly used in mPC, however few data are available on their impact on cognition in elderly patients (pts).MethodsThe COG-PRO trial was designed to assess cognition in castration-resistant mPC (mCRPC) pts aged ≥70 before initiation of ARPI (enzalutamide or abiraterone acetate plus prednisone) in addition to ADT, and after 3, 6, and 12 months, compared with pts receiving ADT alone, and healthy controls (HC). SC was examined with the Perceived cognitive impairment (PCI) and abilities (PCA) subscales of the FACT-COG questionnaire, and OC with cognitive tests assessing 6 objective domains (processing speed / attention, working memory, verbal memory, visual memory, visuospatial abilities, and executive functions). Overall OC impairment at baseline and OC declines during follow-up were estimated using ICCTF guidelines and reliable change index, respectively. Adjusted scores were then analyzed using linear models for objective domains separately and for SC.ResultsThe analysis was conducted in 74 ADT+ARPI pts, 19 ADT pts, and 30 HC (aged 78, 74, and 75, respectively). At baseline, 51% of ADT+ARPI pts had overall OC impairment, vs. 26% of ADT pts (p=0.072) and 10% of HC (p<0.001). During follow-up, incidence of overall OC decline in ADT+ARPI pts ranged from 2% to 6%. Adjusted scores showed lower performance in mPC pts compared to HC throughout follow-up in processing speed/attention, working memory, verbal memory and executive function (p≤0.027) and for SC (PCI: p≤0.005). Adjusted scores also showed lower performance for ADT+ARPI pts compared to ADT pts for processing speed/attention at each visit (p≤0.010). ADT+ARPI pts also reported poorer SC in the first 6 months of treatment compared to ADT (PCA: p≤0.033).ConclusionsCognitive impairment is frequent in elderly mPC patients treated with ADT. ARPI appear to enhance the adverse cognitive effects ADT on OC and SC, and this should be considered in elderly pts candidates for these treatments.

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