Treatment Pattern and Outcomes with Systemic Therapy in Men with Metastatic Prostate Cancer in the Real-World Patients in the United States

Abstract

Background: Both novel hormonal therapies and docetaxel are approved for treatment of metastatic prostate cancer (mPC; in castration sensitive or refractory settings). Present knowledge gaps include lack of real-world data on treatment patterns in patients with newly diagnosed mPC, and comparative effectiveness of novel hormonal therapies (NHT) versus docetaxel after treatment with a prior NHT. Methods: Herein we extracted patient-level data from a large real-world database of patients with mPC in United States. Utilization of NHT or docetaxel for mPC and comparative effectiveness of an alternate NHT versus docetaxel after one prior NHT was evaluated. Comparative effectiveness was examined via Cox proportional hazards model with propensity score matching weights. Each patient’s propensity for treatment was modeled via random forest based on 22 factors potentially driving treatment selection. Results: The majority of patients (54%) received only androgen deprivation therapy for mPC. In patients treated with an NHT, alternate NHT was the most common next therapy and was associated with improved median overall survival over docetaxel (abiraterone followed by docetaxel vs. enzalutamide (8.7 vs. 15.6 months; adjusted hazards ratio; aHR 1.32; p = 0.009; and enzalutamide followed by docetaxel vs. abiraterone (9.7 vs. 13.2 months aHR 1.40; p = 0.009). Limitations of the study include retrospective design.

Treatment Patterns Among Patients With Advanced Prostate Cancer in Brazil: An Analysis of a Private Healthcare System Database

“…Despite the mounting body of evidence supporting the superiority of adding another drug such as docetaxel and abiraterone (and enzalutamide and apalutamide later) to ADT for patients with metastatic hormone-sensitive prostate cancer, most patients with metastatic disease had received ADT monotherapy (50.8%) or ADT plus a first-generation anti-androgen (28.7%) before their mCRPC diagnosis. This finding mirrors the results of real-world treatment patterns found in the US health insurance database [ 27 ] and may be due to regulatory approvals, which currently do not include NHTs in the minimum mandatory reimbursement for metastatic castration-sensitive prostate cancer.…”

Combination therapy in metastatic hormone-sensitive prostate cancer: is three a crowd?

“…Unfortunately, the clinical and patient communities have unfortunately not yet implemented even the evidence for doublet therapies effectively into clinical practice. 42 – 46 The evidence is clear; it is equally clear that we still have far to go to deliver optimal treatment to those who need it most.…”

Genomic landscape of advanced prostate cancer patients with BRCA1 versus BRCA2 mutations as detected by comprehensive genomic profiling of cell-free DNA

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