Real-World Treatment Patterns and Overall Survival of Patients with Metastatic Castration-Resistant Prostate Cancer in the US Prior to PARP Inhibitors

• Published in: Advances in therapy Vol. 38; no. 8; pp. 4520 - 4540
• Main Authors: Shore, Neal D., Laliberté, François, Ionescu-Ittu, Raluca, Yang, Lingfeng, Mahendran, Malena, Lejeune, Dominique, Yu, Louise H., Burgents, Joseph, Duh, Mei Sheng, Ghate, Sameer R.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.08.2021
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cardiology; Endocrinology; Humans; Internal Medicine; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Oncology; Original Research; Pharmacology/Toxicology; Poly(ADP-ribose) Polymerase Inhibitors - therapeutic use; Prostatic Neoplasms, Castration-Resistant - drug therapy; Retrospective Studies; Rheumatology; Next-generation hormonal agents; Chemotherapy; Treatment duration; Electronic medical records; Lines of therapy
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-021-01823-6

Introduction Therapeutic options for metastatic castration-resistant prostate cancer (mCRPC) patients are continuously advancing. We described mCRPC treatment patterns in the US from 2013 to 2019. Methods Patients with a confirmed mCRPC diagnosis and adenocarcinoma histology were included in the US Flatiron Health Electronic Health Record-derived de-identified database. Treatment patterns [including treatment per lines of therapies (LOTs), LOT sequences, and time on treatment] and overall survival (OS) have been described in mCRPC settings. Results Of 5213 patients (mean age: 72.6 years), 4374 (83.9%) were treated with ≥ 1 LOT post-mCRPC diagnosis (among those with ≥ 1 LOT, 55.3%, 29.5%, 14.7%, and 6.7% had ≥ 2, 3, 4, and 5 LOTs, respectively). In first line (1L), the main treatment class was next-generation hormonal agents (NHA; 62.5% of patients with ≥ 1 LOT), while the shortest and longest time on 1L were observed for chemotherapy (median 2.8 months) and NHA (median 5.1 months), respectively. The most common LOT sequences were NHA → NHA (29.4% of patients with ≥ 2 LOTs) and NHA → NHA → chemotherapy (16.7% of patients with ≥ 3 LOTs). In Kaplan–Meier analyses, the median OS was 19.4, 14.6, and 11.1 months post-1L, 2L, and 3L start, respectively. Patients who moved rapidly through LOTs had an increased risk of death. Conclusions NHA were widely used as 1L therapy in mCRPC patients from 2013 to 2019, but time on 1L NHA treatment was on average < 6 months. While NHA → NHA was the most observed 1L → 2L LOT sequence, a plethora of other LOT sequences were observed. OS was poor, highlighting an unmet need for life-prolonging treatments.