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. 2024 Nov 27;14(11):e090013.
doi: 10.1136/bmjopen-2024-090013.

A modified Delphi consensus regarding the clinical utility of triplet therapy in patients with metastatic hormone-sensitive prostate cancer patients in the UK

Hilary Glen  1 , Amit Bahl  2 , Louisa Fleure  3 , Noel Clarke  4   5 , Suneil Jain  6 , Tania Kalsi  7 , Vincent Khoo  8 , Junaid Mobeen  9
Affiliations

A modified Delphi consensus regarding the clinical utility of triplet therapy in patients with metastatic hormone-sensitive prostate cancer patients in the UK

Hilary Glen et al. BMJ Open. .

Abstract

Objectives: This study aimed to determine the clinical utility of the androgen deprivation therapy (ADT)+docetaxel (DOCE)+androgen receptor-targeted agent (ARTA) triplet therapy in patients with metastatic hormone-sensitive prostate cancer (mHSPC) in the UK.

Design: A modified Delphi method. A steering group of eight UK healthcare professionals experienced in prostate cancer care discussed treatment challenges, developing 39 consensus statements across four topics. Agreement with the statements was tested with a broader panel of professionals within this therapeutic area in the UK through an anonymous survey, using a four-point Likert scale. This was distributed by the steering group members and an independent third party. Following the survey, the steering group convened to discuss the results and formulate recommendations.

Setting: The steering group convened online for discussions. The survey was distributed via email by the clinicians and the independent third party.

Participants: Healthcare professionals involved in the provision of prostate cancer care, working in relevant professional roles (oncology, urology or geriatric consultant, oncology nurse specialist, and hospital pharmacist) within the UK. No patients or members of the public were involved within the study.

Interventions: None.

Primary and secondary outcome measures: Consensus was defined as high (≥75% agreement) and very high (≥90% agreement).

Results: Responses were received from 120 healthcare professionals, including oncologists (n=73), urologists (n=16), geriatricians (n=15), nurse specialists (n=11) and hospital pharmacists (n=5). Consensus was reached for 37 out of 39 (95%) statements, and 27/39 (69%) statements achieved very high agreement ≥90%. Consensus was not reached for 2/39 (5%) statements.

Conclusions: Based on the consensus observed, the steering group developed a set of recommendations for the clinical utility of ADT+DOCE+ARTA in treating patients with mHSPC in the UK. Following these recommendations enables clinicians to identify appropriate patients with mHSPC for triplet treatment, thereby improving patients' outcomes.

Keywords: CHEMOTHERAPY; Prostate; Prostatic Neoplasms; Protocols & guidelines.

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Conflict of interest statement

Competing interests: All authors received funding from Bayer while undertaking this study. Client commissioned Triducive Partners Limited to facilitate the project and analyse the responses to the consensus statements in line with the Delphi methodology. HG has received honoraria from ACCORD, Astellas, AstraZeneca, Bayer, Ferring, Janssen, and Pfizer. AB has received honoraria, and undertaken advisory boards and meeting sponsorships for ACCORD, Astellas, Bayer, BMS, Janssen, and Novartis. AB has received institutional research grants from Bayer, Janssen, and Regeneron. LF has received honoraria from ACCORD, Astellas, AstraZeneca, Bayer, Ipsen, and Novartis. NC has received honoraria, and undertaken advisory boards and lectures for Astellas, AstraZeneca, Bayer, Ipsen, Janssen, Merck and Pfizer. NC has received research funding via the STAMPEDE Trial from Astellas, Janssen, and Novartis. NC reports academic conflicts from STAMPEDE, Radicals, Propel, and Patch trials. SJ has received honoraria for advisory boards, speaker fees, consultancy, and travel from ACCORD, Accuray, Astellas, AstraZeneca, Bayer, Boston Scientific, BXT Nanotherapy, Janssen, and Pfizer. TK has received honoraria from AstraZeneca, Bayer, ESMO, and Janssen for educational events and expert consensus work. VK has received honoraria and non-financial support for advisory, speaker forums and conferences from Accuray, Astellas, Astra Zeneca, Bayer, Bristol Myers Squibb, Boston Scientific, Janssen, Merck Serono, Merck Sharp & Dohme, and Novartis. JM has received honoraria from Astellas and Bayer.

Figures

Figure 1
Figure 1. Modified Delphi study design.
Figure 2
Figure 2. Consensus agreement levels by statement. The threshold for consensus is depicted by the green line (75%). The blue line signifies the threshold for very strong agreement (90%).
See this image and copyright information in PMC

References

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