Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review

Abstract

Background: Orally administrated agents play a key role in the management of prostate cancer, providing a convenient and cost-effective treatment option for patients. However, they are also associated with adherence issues which can compromise therapeutic outcomes. This scoping review identifies and summarizes data on adherence to oral hormonal therapy in advanced prostate cancer and discusses associated factors and strategies for improving adherence. Methods: PubMed (inception to 27 January 2022) and conference databases (2020–2021) were searched to identify English language reports of real-world and clinical trial data on adherence to oral hormonal therapy in prostate cancer using the key search terms ‘prostate cancer’ AND ‘adherence’ AND ‘oral therapy’ OR respective aliases. Results: Most adherence outcome data were based on the use of androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (mCRPC). Self-reported and observer-reported adherence data were used. The most common observer-reported measure, medication possession ratio, showed that the vast majority of patients were in possession of their medication, although proportion of days covered and persistence rates were considerably lower, raising the question whether patients were consistently receiving their treatment. Study follow-up for adherence was generally around 6 months up to 1 year. Studies also indicate that persistence may drop further with longer follow-up, especially in the non-mCRPC setting, which may be a concern when years of therapy are required. Conclusions: Oral hormonal therapy plays an important role in the treatment of advanced prostate cancer. Data on adherence to oral hormonal therapies in prostate cancer were generally of low quality, with high heterogeneity and inconsistent reporting across studies. Short study follow-up for adherence and focus on medication possession rates may further limit relevance of available data, especially in settings that require long-term treatment. Additional research is required to comprehensively assess adherence.

Consensus on safety management of novel hormonal therapy for advanced prostate cancer

“…CHART [25] mHSPC Rezvilutamide + ADT versus bicalutamide + ADT rPFS: NE versus 25.1 m (HR: 0.44; 95% CI: 0.33-0.58, p < 0.001) LATITUDE [26] mHSPC Abiraterone + prednisone + ADT versus prednisone + ADT OS: 53.3 versus 36.5 m (HR: 0.66; 95% CI: 0.56-0.78, p < 0.001) COU-AA-302 [27] reported a discontinuation rate of 9.4% due to AEs. These findings emphasize the negative influence of reduced therapy compliance on patients' OS [19,21,41] . In addition, AEs, such as fatigue, pain, and fracture that may be experienced during apalutamide treatment have a significant impact on patients' QoL.…”

Advances in Small Molecular Agents against Oral Cancer

“…In addition, it can cause cell cycle arrest by disrupting Wnt, mTOR, and NF-xB signals and preventing the invasion and migration of cancer cells. Quercetin (19) can cause mitochondrial dys-function and inhibit the viability, migration, and invasion of OCC via the mitochondrial apoptosis pathway [53,54]. Baicalein (20) induces the apoptosis, causes the GO/G1 phase arrest, and reduces the NF-κB activity of OSCC cells.…”

“…Despite advances in diagnostic imaging, surgery, radiation, and chemotherapy, oral cancer is often diagnosed at a later stage of disease development, leading to poor prognosis and high mortality. Moreover, many patients with oral cancer are resistant to standard treatments owing to heterogeneity within the tumour or a genetic mutation which occurs during treatment, resulting in the high recurrence rate of this disease [19][20][21]. Oral cancer metastasises to various tissues or organs of the body through the lymphatic system or blood, and generally has no specific location, but it is more likely to metastasise to the head and neck area [20].…”