Real-world first-line (1L) treatment patterns in patients (pts) with metastatic castration-sensitive prostate cancer (mCSPC) in a U.S. health insurance database.

Abstract

5072 Background: Over the past 6 years, intensification of androgen deprivation therapy (ADT) with docetaxel (DOC) and novel hormonal therapies (NHT) [abiraterone, enzalutamide, and apalutamide], has been shown to improve survival outcomes in men with mCSPC. This study assessed the real-world utilization of effective combination therapies as 1L treatment in insured pts in the U.S. with mCSPC. Methods: This retrospective study used the Optum health insurance claims database, which includes pt claims data from both commercially insured and Medicare Advantage populations. Eligible pts were adult men with ≥1 claim with a metastatic International Classification of Diseases diagnostic code (first claim was index date) within 90 days (d) prior to, or any time after, a prostate cancer diagnosis between January 2014 and June 2019. Pts with evidence of systemic anticancer therapy during the 1-year pre-index baseline period were excluded, unless the first drug claim occurred within 90 d prior to the diagnosis of metastatic disease. The 1L treatments were identified as any treatment for mCSPC within 90 d pre-index, plus any other treatment received within 180 d of the first, and were grouped by regimen: ADT only; ADT + first-generation antiandrogens (AA); ADT + DOC; ADT + NHT; and ADT + NHT + DOC. Results: Of 4221 men with mCSPC, 2364 (56.0%) received ADT only; 892 (21.1%) ADT + AA; 577 (13.7%) ADT + NHT; 348 (8.2%) ADT + DOC; and 40 (0.9%) ADT + NHT + DOC. Pts who received ADT + DOC or ADT + DOC + NHT were generally younger than the other treatment groups (Table). By 2019, use of ADT only and ADT + AA had declined, while the use of ADT + NHT and ADT + NHT + DOC had increased (Table). However, in 2018 and 2019, the majority of men with mCSPC still received either ADT alone, or ADT + AA, including those with visceral metastases (Table). Survival analysis across treatment cohorts is ongoing. Conclusions: Despite level 1 evidence demonstrating improved survival with intensified treatment (ADT + DOC or NHT), this study shows its underutilization in pts with mCSPC. This is evident even in those with more aggressive disease (visceral metastases) as recently as 2019. These data highlight that a minority of pts with mCSPC received optimal life-prolonging therapies in a commercially insured and Medicare Advantage U.S. population. Further studies are needed to identify the reasons for this underutilization of intensified treatments.[Table: see text]

Impact of next-generation hormonal agents on treatment patterns among patients with metastatic hormone-sensitive prostate cancer: a real-world study from the United States, five European countries and Japan

“…Likewise, Swami and colleagues [32] found that US patients in the Optum health insurance claims database who received chemotherapy (docetaxel) + ADT or NHA + ADT were younger (mean 68 and 73 years, respectively) than patients who received ADT alone (mean 75 years), although, unlike in the present survey, a greater proportion of patients with more aggressive disease (i.e., visceral metastases) received ADT alone (55%) vs chemotherapy + ADT (9%) or NHA + ADT (17%). Younger age in chemotherapy + ADT-treated men with mHSPC was also observed by Tagawa et al [33], who also found that patients treated with NHA (abiraterone) + ADT or chemotherapy (docetaxel) + ADT were more likely to have metastatic disease in lymph nodes (also observed in our survey) and other sites at treatment initiation.…”

“…Previous real-world investigations in the US, evaluating care in mHSPC patients who initiated treatment between 2014 and 2019, reported that overall (i.e., over the entire period), ADT alone was the most common mHSPC regimen initiated, with rates ranging from 47 to 63%. In contrast, NHA use over the same period was low (5-14%) [30][31][32][33], although this finding is unsurprising given that NHAs in the mHSPC setting did not receive US Food and Drug Administration approval until 2018-2019. Indeed, Ke et al [31] reported that mHSPC patients in their 2017-2018 cohort were less often receiving ADT alone (43% vs 52%) and more often abiraterone (10% vs 4%) as initial regimen compared with the 2015-2016 cohort.…”

“…Indeed, Ke et al [31] reported that mHSPC patients in their 2017-2018 cohort were less often receiving ADT alone (43% vs 52%) and more often abiraterone (10% vs 4%) as initial regimen compared with the 2015-2016 cohort. Nevertheless, Swami et al [32] recently pointed out that in 2018-2019, most men with mHSPC in the Optum health insurance claims database still received ADT alone, including those with visceral metastases (55%); the equivalent rate for NHA + ADT for the same group was 17%. Likewise, George et al [4] reported that even in 2019, over half of mHSPC patients treated in real-world settings (oncology practices in the ConcertAI Oncology Dataset) did not initiate therapy now known to significantly improve survival (NHA + ADT or NHA + docetaxel) over ADT alone.…”

“…As NHAs have been approved only relatively recently, there are currently few real-world published data assessing NHA use in the mHSPC space [30]; these are restricted to the US, and largely based on data collected prior to NHA approvals for mHSPC. They indicate that, despite the emergence of docetaxel or NHA combination therapies, a large proportion of men continue to be treated with ADT alone [30][31][32][33].…”

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

“…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).…”