Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review

Grochtdreis, Thomas; König, Hans‐Helmut; Dobruschkin, Alexander; Amsberg, Gunhild von; Dams, Judith

doi:10.1371/journal.pone.0208063

Cited by 25 publications

(20 citation statements)

References 112 publications

(230 reference statements)

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“…Four to six cycles administered on an outpatient basis compares very favourably to standard therapeutic regimens in formal cost-effectiveness studies performed in metastatic castrate-resistant prostate cancer. [33][34][35][36] Several studies have demonstrated an improvement in quality of life as well as in outcome measures following RLT. Side effects occur less frequently than with standard third-line therapies and are mostly treated without the need for hospital admission.…”

Section: Cost-effectivenessmentioning

confidence: 99%

South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer

et al. 2019

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Background: Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct identification and treatment of patients who are likely to benefit from receptor radioligand therapy. Recommendations: There are a multitude of treatment modalities available for the treatment of prostate cancer and these therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and should ideally also involve a palliative/pain specialist, a dietician and a psychologist. Conclusion: Treatment with 177 Lu-PSMA has emerged as a promising systemic modality, which involves the delivery of targeted radiation therapy in the form of β-particles to sites of tumour tissue. Therapy is provided on an outpatient basis, is well tolerated with relatively few side effects and has a positive effect on overall survival and quality of life. At present, it is used mostly in the setting of advanced, castrate-resistant cancer. Patients are selected (amongst other criteria) based on the prior PSMA-based SPECT/PET/CT imaging ( 99m Tc-, 68 Ga-or 18 F-PSMA), which should demonstrate sufficient receptor expression in order to consider PSMA-based targeted radionuclide therapy. Such imaging of an intended target prior to its therapeutic targeting is known as a theranostic approach.

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Section: Cost-effectivenessmentioning

confidence: 99%

South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer

et al. 2019

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“…Ultimately, the cumulative lifetime costs of a patient's systemic therapies can be substantial, potentially dwarfing the cost of their original definitive local therapy. 20 The ideal of personalized medicine is to individualize care by identifying and targeting the unique molecular characteristics of a given patient or tumor; however, prostate cancer has historically been bereft of such targetable markers of response and resistance. 6,21 A validated and commercially available panel of biomarkers to guide the sequencing of subsequent treatments would be ideal, such that therapies that are likely to be ineffective could be avoided.…”

Section: Introductionmentioning

confidence: 99%

Androgen Receptor Splice Variant, AR-V7, as a Biomarker of Resistance to Androgen Axis-Targeted Therapies in Advanced Prostate Cancer

Zhang

Karsh

Nissenblatt

et al. 2020

Clinical Genitourinary Cancer

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Many therapeutic options are now available for men with metastatic castration-resistant prostate cancer (mCRPC), including next-generation androgen receptor axis-targeted therapies (AATTs), immunotherapy, chemotherapy, and radioisotope therapies. No clear consensus has been reached for the optimal sequencing of treatments for patients with mCRPC, and few well-validated molecular markers exist to guide the treatment decisions for individual patients. The androgen receptor splice variant 7 (AR-V7), a splice variant of the androgen receptor mRNA resulting in the truncation of the ligand-binding domain, has emerged as a biomarker for resistance to AATT. AR-V7 expression in circulating tumor cells has been associated with poor outcomes in patients treated with second-and third-line AATTs. Clinically validated assays are now commercially available for the AR-V7 biomarker. In the present review of the current literature, we have summarized the biology of resistance to AATT, with a focus on the AR-V7; and the clinical studies that have validated AR-V7 expression as a strong independent predictor of a lack of clinical benefit from AATTs. Existing evidence has indicated that patients with AR-V7epositive mCRPC will have better outcomes if treated with taxane chemotherapy regimens rather than additional AATTs.

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“…Also, the onset of metastatic CRPC (mCRPC) appears to be an objective endpoint and has already been shown to be a good surrogate for overall survival in post-prostatectomy patients with second biochemical recurrence following salvage RT [ 18 ]. Moreover, these endpoints are also economically interesting as postponement of the onset of palliative ADT and/or mCRPC, might save a huge amount of money and improve the patient’s quality of life [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

Devos

Berghen

Eecke

et al. 2020

Cancers

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Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials.

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Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review

Cited by 25 publications

References 112 publications

South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer

South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer

Androgen Receptor Splice Variant, AR-V7, as a Biomarker of Resistance to Androgen Axis-Targeted Therapies in Advanced Prostate Cancer

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

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