OS and Adverse Events Observed in CAPItello-281

Balancing efficacy and tolerability remains essential when introducing targeted combinations into frontline prostate cancer therapy. Gordon A. Brown, DO, FACOS, an associate professor at Rowan University School of Osteopathic Medicine, program director of Urologic Surgery at Rowan University School of Osteopathic Medicine, and director of New Jersey Urology’s Center for Advanced Therapeutics, discusses overall survival results from CAPItello-281 (NCT04493853), noting an early favorable trend with an HR of 0.90, although data remain immature. Continued follow-up will determine whether survival outcomes ultimately mirror the improvements observed in rPFS.

The safety profile of capivasertib plus abiraterone was consistent with prior experience using AKT inhibitors. Brown reports that common adverse events included hyperglycemia, gastrointestinal toxicity such as diarrhea, and dermatologic reactions. Grade 3 or higher events were relatively frequent, and approximately 18% of patients discontinued therapy because of toxicity, emphasizing the need for proactive management.

From a clinical perspective, Brown stresses the importance of patient education, multidisciplinary support, and dose-modification strategies. Although deaths related to adverse events occurred in both treatment arms, overall rates were low. When weighed against the aggressive natural history of PTEN-deficient disease, he notes that the risk-benefit profile supports treatment intensification in appropriately selected patients with careful monitoring.