Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Pharmaceutical Sciences

First Advisor

Dr. Chris Delcher

Second Advisor

Dr. Val Adams


Prostate cancer has the highest increasing rate and new cases among all cancer in men in the United States and has a higher risk in elderly men. Metastatic castration-resistant prostate cancer (mCRPC) is the late stage of prostate cancer and associated with poor prognosis (median survival 13 months). Androgen deprivation therapy (ADT) use with novel hormone therapy or standard chemotherapy are recommended for mCRPC treatment. Although, the treatment options expanded significantly in recent years, new challenges are present because of the aging population, larger treatment spectrum and co-administrated medication use for other underlying medical conditions, especially for cardiovascular disease (CVD), for several reasons. First, patients with mCRPC are more likely to be old and with pre-existing cardiovascular disease that need anticoagulants. However, enzalutamide, a commonly used novel hormone therapy, is a CYP3A4, CYP2C19, CYP2C9 inducer and has drug-drug interactions (DDIs) with certain anticoagulants and may lead to harmful effects. Secondly, cardiovascular toxicity was also reported for ADT and novel second generation of hormone therapy including abiraterone acetate and enzalutamide. This dissertation aims to better understand real-world utilization and drug safety of mCRPC treatments from different perspectives. Specifically, the objectives are 1) to characterize DDIs in treatment patterns in patients with mCRPC, 2) to characterize prescribing pattern of DDIs, using concomitant use of enzalutamide and anticoagulation as example, and 3) to compare the cardiovascular risk in patients received enzalutamide and abiraterone. The findings of this dissertation are critical in optimizing the medication use and safety and strengthening healthcare continuity for patients with mCRPC.

Digital Object Identifier (DOI)

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