Abiraterone acetate + prednisolone treatment beyond prostate specific antigen and radiographic progression in metastatic castration-resistant prostate cancer patients

Bíró, Krisztina; Budai, Barna; Szőnyi, M.; Küronya, Zsófia; Gyergyay, Fruzsina; Nagyiványi, Krisztián; Gergely, Lajos

doi:10.1016/j.urolonc.2017.10.015

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…Again, enzalutamide continuation despite PSA nadir was associated with a clinically meaningful interval without radiographic or clinical progression. Our study is consistent with a recently published study, which suggested an OS benefit for patients treated with abiraterone and prednisone despite PSA and radiographic progression, relative to patients whose therapy was stopped pending for radiographic and/or PSA progression (12).…”

Section: Discussionsupporting

confidence: 92%

Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression

et al. 2019

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Background/Aim: National guidelines offer little guidance on the use of PSA progression (PSA increase as defined below) as a clinical endpoint in metastatic castrationresistant prostate cancer (mCRPC). The aim of the study was to examine treatment patterns/outcomes with abiraterone (abi)/enzalutamide (enza) throughout PSA progression and near the end of life (EOL). Patients and Methods: Cases of mCRPC treated with abi or enza from the New York Veterans Affairs (VA) from 6/2011-8/2017 were reviewed. Regression analyses were conducted to identify factors associated with continuation of abi/enza treatment up to the EOL, and survival. Results: Of 184 patients, 72 received abi alone, 28 received enza alone, and 84 received both. Treatment was changed for PSA progression alone in 39.1% (abi) and 25.7% (enza) of patients. A total of 37 patients (20%) received abi/enza within 1 month before death, 30% of whom were receiving hospice services. Older patients and black patients were less likely to receive abi/enza up to the EOL. Conclusion: Abi/enza are frequently discontinued for PSA progression alone and continued at EOL. The clinical benefit of these practices warrants additional study. Materials and Methods Study design. A multi-center, retrospective cohort study of patients with advanced prostate cancer at 2 participating VA medical centers (Manhattan, Brooklyn) was conducted to characterize abiraterone and enzalutamide treatment and patient outcomes. The study was approved by the institutional review board. Population and variables. A total of 184 patients with metastatic prostate cancer who received prescriptions for abiraterone acetate or 2467 This article is freely accessible online.

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Section: Discussionsupporting

confidence: 92%

Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression

et al. 2019

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“…However, when we consider the extensive use of rechallenged treatment regimens, the duration of treatment is longer than expected. A recent study conducted in Hungary, Biró et al demonstrated that patients continue to derive clinical benefit from active treatment beyond prostate specific antigen and radiographic progression [27]. This may explain in part, the longer persistence in treatment across all therapies.…”

Section: Discussionmentioning

confidence: 99%

Insights into Treatment Patterns in the Routine Care of Patients Diagnosed with Metastatic Castration-Resistant Prostate Cancer in Germany After the Introduction of New Therapies

Justo¹,

Schweikert²,

Simon³

et al. 2020

COR

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Background: Clinical treatment guidelines for metastatic castration-resistant prostate cancer (mCRPC) predominantly rely on the evidence from clinical trials, which frequently apply restrictive eligibility criteria resulting in selected patient populations. Therefore, real world treatment pattern may deviate from recommendations. We aimed to describe treatment patterns including sequencing and treatment duration of patients diagnosed with mCRPC in Germany, by characterizing the demographic and clinical characteristics of patients. Methods: A large German claims database was used to identify males who were diagnosed and treated for mCRPC (ICD-10-GM code C61) between January 2013 and December 2015. Patients were required to be continuously enrolled 12 months before initiation of treatment with abiraterone, cabazitaxel, docetaxel, or enzalutamide. Study endpoints included lines of therapy, treatment duration and treatment sequencing. Treatment duration was calculated via Kaplan-Meier estimates. Results: There were n=447 patients meeting all inclusion criteria in the database. Mean age (±SD) was 72.9 (±8.8) years, mean Charlson comorbidity index was 8.1, there were on average 1.9 hospitalizations within the 12 months before the index, and 70% of patients presented with bone metastasis. Overall, abiraterone was the most commonly prescribed treatment across lines of therapy while cabazitaxel, was the least utilized therapy. The longest treatment duration was seen in abiraterone patients (median duration of 8.3 months in first and 7.4 months in second line). Switches between abiraterone and docetaxel in first and second line were common. Among the 447 patients more than 70 different pathways were identified. Conclusion: There was a significant variability in treatment pathways pointing to a highly individualized treatment approach in spite of detailed treatment algorithms. Even in third line, systemic therapies were still being prescribed. Furthermore, this study showed that routine-care data are a valuable source to assess the actual treatment pathways on a cohort but also on an individual level.

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“…There has been concern that use of ART drugs in clinical practice is continued too long and given that these drugs are expensive and are used by a large number of men with mCRPC, this could have large financial implications. A wide range in time on treatment for these drugs has been reported in previous observational studies, ranging from 3 to 20 months (S1 Table) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 89%

“…treatment for ART with a range from 3 up to more than 20 months, likely due to differences in study design, study population, and definition of drug stop [13][14][15][17][18][19][20][21][22][23][24][25].…”

Section: Plos Onementioning

confidence: 99%

Observational study on time on treatment with abiraterone and enzalutamide

et al. 2020

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Introduction The aim of this study was to assess time on treatment with abiraterone and enzalutamide, two androgen receptor targeted (ART) drugs, the impact on time on treatment of time interval without drug supply between prescription fillings, and adherence to treatment. Material and methods By use of data from The National Prostate Cancer Register, The Prescribed Drug Registry and the Patient Registry, time on treatment with the abiraterone and enzalutamide was analyzed in all men with castration resistant prostate cancer (CRPC) in Sweden 2015–2019. Three time intervals between consecutive fillings, i.e. time without drug supply, were assessed. Adherence to the treatment was evaluated by use of the Medication Possession Ratio. Kaplan Meier analysis and multivariable Cox regression model were used to assess factors affecting time on treatment. Results Between January 2015 and October 2019, 1803 men filled a prescription for abiraterone and 4 534 men filled a prescription for enzalutamide. With a time interval of 30 days or less between two fillings, median time on treatment was 4.9 months (IQR 2.6–11.7) for abiraterone and 8.0 months (IQR 3.6–16.4) for enzalutamide. In sensitivity analyses, allowing for no more than 14 days without drug supply between fillings, median time on treatment was 3.9 months (IQR 2.1–9.0) for abiraterone and 5.9 months (IQR 2.8–12.1) for enzalutamide. Allowing for any time period without drug between fillings, median time on treatment was 5.7 months (IQR 2.7–14.0) for abiraterone and 9.8 months (IQR 4.4–21.0) for enzalutamide. Adherence to treatment was above 90% for both drugs. Conclusion Time on treatment with abiraterone and enzalutamide was shorter in clinical practice than in randomized controlled trials and varied almost two-fold with time interval without drug. Adherence to treatment was high. The main limitation of our study was the lack of data on use of chemotherapy.

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Abiraterone acetate + prednisolone treatment beyond prostate specific antigen and radiographic progression in metastatic castration-resistant prostate cancer patients

Cited by 4 publications

References 25 publications

Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression

Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression

Insights into Treatment Patterns in the Routine Care of Patients Diagnosed with Metastatic Castration-Resistant Prostate Cancer in Germany After the Introduction of New Therapies

Observational study on time on treatment with abiraterone and enzalutamide

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