Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review

Abstract

Objective: To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC). While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade.

Methods: We searched electronic databases (PubMed; Excerpta Medica dataBASE [EMBASE]) for eligible studies (retrospective or prospective observational RWD studies examining mHSPC treatment patterns) between database inception and July 2023, and manually screened the past 2 years of relevant conference proceedings.

Results: Of 2336 retrieved citations, 29 studies met the inclusion criteria, covering North America (United States, n = 21; Canada, n = 2), Europe (n = 8), and Asia (n = 6). Most studies utilised retrospective cohorts (n = 26) and included men with a median age of ≥70 years (n = 20). ADT monotherapy was predominantly used across geographies, followed by ADT + ARPI and ADT + docetaxel in the United States and Europe but not in Asia, where use of each combination remained low. Studies with recent electronic medical record data from cancer centres/registries showed >40% use of ADT + ARPI in the United States and Europe. Abiraterone was the most frequently used ARPI, followed by enzalutamide. Quantitative factors associated with ADT intensification were high disease burden, younger age, Eastern Cooperative Oncology Group performance status score of 0 to 1, fewer comorbidities, and oncologist physician specialty; qualitative factors were patient preference, unsatisfactory response to ADT, ability to tolerate adverse events, and absence of cost barriers.

Conclusion: While there was an increasing trend in ADT intensification for mHSPC over the study period across geographies, use remained suboptimal considering the high proportion of patients who were still receiving ADT monotherapy only. These findings highlight the need for interventions to further optimise current mHSPC therapies with high guideline concordance.

Keywords: androgen receptor pathway inhibitors; androgen‐deprivation therapy; metastatic hormone‐sensitive prostate cancer; real world; treatment patterns.

Fig. 1

Trends in ADT intensification by RWD types in (A) the United States, (B) Europe, and (C) Asia. ^aBarata et al. [37] reported data from European countries such as the UK, France, Germany, Spain, and Italy. ^bYang et al. [47] reported data from Singapore, Asia. ADT, androgen deprivation therapy; ARPI, androgen receptor pathway inhibitor; CTCA, Cancer Treatment Centers of America; DOC, docetaxel; EMR, electronic medical records; RWD, real‐world data; VHA, Veterans Health Administration.

Fig. 2

Utilisation patterns of ARPI in (A) the United States and Canada, (B) Europe, and (C) Asia. ABI, abiraterone; APA, apalutamide; ARPI, androgen receptor pathway inhibitor; DARO, darolutamide; ENZA, enzalutamide; GOMD, Global Oncology Monitor Database; VHA, Veterans Health Administration.