Real-World Treatment Patterns Among Patients With Metastatic Castration-Resistant Prostate Cancer: Results From an International Study

Abstract

Background: There is limited real-world evidence on how increasing use of treatment intensification in metastatic castration-sensitive prostate cancer (mCSPC) has influenced treatment decisions in metastatic castration-resistant prostate cancer (mCRPC). The study objective was to evaluate the impact of novel hormonal therapy (NHT) and docetaxel use in mCSPC on first-line treatment patterns among patients with mCRPC in 5 European countries and the United States (US).

Methods: Physician-reported data on patients with mCRPC from the Adelphi Prostate Cancer Disease Specific Program were descriptively analyzed.

Results: A total of 215 physicians provided data on 722 patients with mCRPC. Across 5 European countries and the US, 65% and 75% of patients, respectively, received NHT, and 28% and 9% of patients, respectively, received taxane chemotherapy as first-line mCRPC treatment. In Europe, patients who had received NHT in mCSPC (n = 76) mostly received taxane chemotherapy in mCRPC (55%). Patients who had received taxane chemotherapy, or who did not receive taxane chemotherapy or NHT in mCSPC (n = 98 and 434, respectively) mostly received NHT in mCRPC (62% and 73%, respectively). In the US, patients who had received NHT, taxane chemotherapy, or neither in mCSPC (n = 32, 12, and 72, respectively) mostly received NHT in mCRPC (53%, 83%, and 83%, respectively). Two patients in Europe were rechallenged with the same NHT.

Conclusions: These findings suggest that physicians consider mCSPC treatment history when making first-line treatment decisions in mCRPC. Further studies are needed to better understand optimal treatment sequencing, especially as new treatments emerge.

Keywords: androgen antagonists; castration-resistant/drug therapy; disease management; prostatic neoplasms.

Figure 1.

mCRPC treatment patterns among patients across 5 European countries. mCRPC treatment patterns across 5 European countries by mCSPC treatment history: (A) mCRPC treatment patterns among patients across 5 European countries with no NHT and no taxane chemotherapy treatment in mCSPC (n = 434); (B) mCRPC treatment patterns among patients across 5 European countries who received treatment with an NHT in mCSPC (n = 76); (C) mCRPC treatment patterns among patients across 5 European countries who received treatment with taxane chemotherapy in mCSPC (n = 98). Five European countries include: UK, France, Germany, Spain, and Italy. ^aOther treatments include, from top to bottom: radium-223-containing regimen (no sipuleucel-T), diethylstilbestrol, paclitaxel + carboplatin. ^bOther treatments include, from top to bottom: bisphosphonates, radium-223-containing regimen (no sipuleucel-T). ^cOther treatments include, from top to bottom: bisphosphonates, sipuleucel-T-containing regimen (no radium-223), bisphosphonates, abiraterone + enzalutamide. Abbreviations: ADT, androgen deprivation therapy; CT, chemotherapy; mCRPC, metastatic castration-resistant prostate cancer; mCSPC, metastatic castration-sensitive prostate cancer; NHT, novel hormonal therapy; NSAA, nonsteroidal anti-androgen; UK, United Kingdom.

Figure 2.

mCRPC treatment patterns among patients in the US who received treatment with an NHT in mCSPC. mCRPC treatment patterns in the US by mCSPC NHT treatment history (n = 32). ^aOther treatments include: cisplatin, cabazitaxel + docetaxel. Abbreviations: ADT, androgen deprivation therapy; mCRPC, metastatic castration-resistant prostate cancer; mCSPC, metastatic castration-sensitive prostate cancer; NHT, novel hormonal therapy; NSAA, nonsteroidal anti-androgen; US, United States.