Metastatic Castration-Resistant Prostate Cancer Previously Treated With Docetaxel-Based Chemotherapy: Treatment Patterns From the PROXIMA Prospective Registry

Abstract

PurposeThere is a major clinical need to devise an optimal treatment sequence for the multiple therapy options available for patients with metastatic castration-resistant prostate cancer (mCRPC). In the absence of prospective clinical trials, sequencing information can be derived from large, real-world registry studies.Patients and MethodsPROXIMA (Treatment Patterns in Patients With Metastatic Castration-Resistant Prostate Cancer Previously Treated With Docetaxel-Based Chemotherapy) is a large, global, prospective registry study evaluating real-world treatment patterns of patients with mCRPC who experience disease progression during or after docetaxel therapy. Patients were enrolled worldwide between 2011 and 2014. Treatments were determined by the treating physicians and recorded in categories of chemotherapy, hormonal therapy, targeted therapy, immunotherapy, and palliative therapy. Treatment sequencing patterns, response to treatment, and types of progression were recorded and analyzed. Progression-free survival and overall survival with different treatment modalities were analyzed using Kaplan–Meier method.ResultsTreatment patterns were evaluated in 903 patients. Therapy selection was influenced by region. Hormonal therapy (57.5%) and taxane chemotherapy (26.4%) were the most frequently administered first subsequent treatments after docetaxel. Tumor responses to first subsequent treatment were observed in 22.6% of evaluable patients. Overall survival and progression-free survival did not differ significantly across different treatment modalities.ConclusionIdentifying an optimal treatment sequence is vital for improving the care of patients with mCRPC. The PROXIMA registry provided a representative sample of global data on real-world treatment patterns for patients with mCRPC previously treated with docetaxel. These data can be used to devise optimal therapy sequences and inform treatment decisions.

Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway?

“…Typically, metastatic disease developed after an initial period of locally or locoregionally confined cancer. These characteristics resemble those reported in other studies from nonarctic regions [4,5,12].…”

“…Commonly, patients with performance status 0-1 (corresponding to Karnofsky score 80-100) and without contraindications to one or several of these approved drugs receive sequential treatment [4,5]. There is no universally agreed sequence of choice.…”

Survival in patients diagnosed with castration-resistant prostate cancer: a population-based observational study in Sweden

“…Survival data for agents used in CRPC have come from randomized controlled studies; however, compared with mCRPC, limited data outside of the clinical trial setting are available for nmCRPC. Population-based PC outcomes, including predictors of time to metastases in CRPC [16], treatment patterns in mCRPC [17,18] and clinical course in patients without metastases at initiating ADT [19] have been described in multiple studies. However, there are limited data focusing on the impact of metastases at initial diagnosis on survival outcomes in CRPC outside of clinical trials [20].…”

PSMA ADC monotherapy in patients with progressive metastatic castration‐resistant prostate cancer following abiraterone and/or enzalutamide: Efficacy and safety in open‐label single‐arm phase 2 study

“…An estimated 174 650 new cases of prostate cancer will be diagnosed in the US in 2019, and 31 620 men are likely to die due to this cancer . Within 3 years of diagnosis, approximately 10% to 50% of patients develop metastatic castration‐resistant prostate cancer (mCRPC) …”

“…3 Within 3 years of diagnosis, approximately 10% to 50% of patients develop metastatic castration-resistant prostate cancer (mCRPC). 4 Primary treatment options for clinically localized prostate cancer vary from active surveillance to surgery (eg, prostatectomy), external beam radiation therapy, or brachytherapy. 5 The backbone of firstline treatment for advanced or recurring tumors continues to be androgen-deprivation therapy (ADT).…”