Treatment patterns in men with metastatic castration sensitive prostate cancer (mCSPC) in the United States (US).

Abstract

e19131 Background: Given recent advances in treatment options for mCSPC, this study assessed US real-world treatment patterns of mCSPC patients over time. Methods: The Optum Clinformatics Extended DataMart was used to identify men with ≥2 claims for PC, ≥1 claim for metastasis, ≥1 castration sensitivity (CS) indicator (CS diagnosis code [dx]; castration and no prostate-specific antigen [PSA] rise; or hormone/castration naive for ≥18 months [mo] before metastasis). Index (idx) date was the 1st metastasis dx date on or after 1st PC dx and from 2015-2018. Patients were excluded if they had a pre-idx castration-resistance (CR) indicator (CR dx; castration within ≥90 days pre-idx or with PSA rise; or a claim for a drug solely recommended for metastatic CRPC). mCSPC period (F/U) was defined as time from idx until CR (i.e., any post-idx CR indicator or initiation of abiraterone acetate [ABI] or docetaxel [DOC] ≥12 mo after post-idx androgen deprivation therapy [ADT] initiation or ≥12 mo post-idx for those with no ADT) or end of data. mCSPC treatment patterns in F/U were assessed overall and in patients with idx years (yrs) in 2015-2016 and in 2017-2018, separately. Descriptive statistics were used: n (%) for binary and mean [SD] for continuous variables. Results: In the 2,825 mCSPC patients identified (age: 75 [9] yrs; F/U: 10.9 [9.0] mo), 43% were in the 2015/16 cohort (age: 75 [9] yrs; F/U: 15.8 [10.2] mo); and 57% were in the 2017/18 cohort (age: 75 [9] yrs; F/U: 7.2 [4.7] mo). The most common first-line (1L) mCSPC therapy was ADT only (Table), but patients in the 2017/18 cohort had fewer ADT only as 1L (43% vs. 52%) and more 1L ABI (10% vs. 4%) compared to the 2015/16 cohort. About 4% (2015/16: 5%; 2017/18: 3%) of patients received second-line (2L) mCSPC therapies, with ABI (74%) and DOC (25%) as the main 2L therapies observed. In patients receiving 2L mCSPC therapies, the 2017/18 cohort had more 2L ABI (81% vs. 68%) and fewer 2L DOC (19% vs. 30%) compared to the 2015/16 cohort. Conclusions: A large proportion of men with mCSPC were untreated/deferred treatment or were treated with ADT only, highlighting unmet needs in this patient group. As additional therapies for mCSPC become available, this trend is expected to improve, as supported by more recent treatment patterns. [Table: see text]

Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration

“…[16][17][18] In line with our study, preliminary results from Ke et al, using a similar study period (2015-2018), indicated that the most common 1L therapy for mCSPC was ADT-only (47%), followed by ADT + docetaxel (8%), ADT + abiraterone (7%), and ADT + NSAA (5%), and that the use of newer therapies had increased yet remained comparatively low. 16,17 Flaig et al found that approximately half of the patients enrolled in a US claims database between 2000 and 2013 received ADT-only, although the study period predated widespread use of docetaxel and NHTs. 18 In both studies, >30% of patients did not receive any pharmacotherapy for mCSPC.…”

Apalutamide in Patients With Metastatic Castration-Sensitive Prostate Cancer: Final Survival Analysis of the Randomized, Double-Blind, Phase III TITAN Study

“…[1][2][3][4] These treatments are now considered standard of care and included in prostate cancer treatment guidelines. [5][6][7] Despite this, new combination treatments with ADT may still be used relatively infrequently, compared with ADT alone, 8,9 owing to concerns about side effects of chemotherapy, prolonged exposure to steroids, the need for patient monitoring, and a lack of long-term follow-up from recently reported studies. Thus, long-term safety data are of interest.…”

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

“…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].…”