Abstract:This study provides a contemporary assessment of the treatment patterns, healthcare resource utilization (HRU), and costs among metastatic castration-sensitive prostate cancer (mCSPC) patients in the US.Methods: Adults with mCSPC were selected from Optum's de-identified Clinformatics® Data
“…Upfront intensification not only prolongs life but does so without compromising quality-of-life as observed in randomized clinical trials [13]. However, retrospective studies (mostly as abstracts) from multiple different databases including Optum, Medicare and ConcertAI Oncology Dataset have shown a consistent underutilization of intensification ranging from < 10% to up to 30% of mCSPC patients and even those with visceral disease and in those with insurance [14][15][16][17]. In our dataset, we confirm that upfront intensification was low but a gradual and encouraging trend towards increased intensification was observed over the last 5 years (Figure 3).…”
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.
“…Upfront intensification not only prolongs life but does so without compromising quality-of-life as observed in randomized clinical trials [13]. However, retrospective studies (mostly as abstracts) from multiple different databases including Optum, Medicare and ConcertAI Oncology Dataset have shown a consistent underutilization of intensification ranging from < 10% to up to 30% of mCSPC patients and even those with visceral disease and in those with insurance [14][15][16][17]. In our dataset, we confirm that upfront intensification was low but a gradual and encouraging trend towards increased intensification was observed over the last 5 years (Figure 3).…”
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.
“…More recently, second generation anti‐androgens, including abiraterone acetate, apalutamide and enzalutamide, have conferred an additional survival benefit when combined with ADT, and also concurrent with docetaxel as trimodal therapy in select patient groups 67,87 . Despite this, many Australian men only receive ADT as primary management for mHSPC 88 . For men with de novo low volume disease, high dose palliative radiotherapy to the prostate also confers an overall survival benefit 74 …”
Section: Advanced Prostate Cancermentioning
confidence: 99%
“…67,87 Despite this, many Australian men only receive ADT as primary management for mHSPC. 88 For men with de novo low volume disease, high dose palliative radiotherapy to the prostate also confers an overall survival benefit. 74 The treatment landscape has vastly changed for mCRPC, defined as biochemical or radiological progression despite castrate serum testosterone levels (< 50 ng/dL or < 1.75 nmol/L).…”
Early detection and management of prostate cancer has evolved over the past decade, with a focus now on harm minimisation and reducing overdiagnosis and overtreatment, given the proven improvements in survival from randomised controlled trials.
“…The real-world data of mHNPC in the U.S., the highest GDP ranked country, demonstrated that the usage of abiraterone was 10% in 2019 and ARATs was 17% in 2020, while around 50% of mHNPC patients still received ADT monotherapy, 5 partially due to the high cost of the drug that will not be covered by the private healthcare system. 5 In the next few years, several novel therapies such as immuno-oncology drug, genome-based companion drugs, and prostate specific membrane antigen based therapy will be introduced on the market in mHNPC. It will be ideal to establish the treatment strategies of mHNPC based on prognosis and cost that will fit among the Asian prostate cancer population to attain the sustainable development goals.…”
Efficacy and safety of abiraterone acetate plus prednisone in Japanese patients with newly diagnosed, metastatic hormone-naive prostate cancer: final subgroup analysis of LATITUDE, a randomized, double-blind, placebocontrolled, phase 3 study.
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