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Real-world Treatment Sequencing in Patients with Metastatic Castration-resistant Prostate Cancer : Results from the Prospective, International, Observational Prostate Cancer Registry

Bjartell, Anders LU ; Costa, Luis ; Kramer, Gero ; Zurawski, Bogdan ; Galli, Luca ; Werbrouck, Patrick ; Ecke, Thorsten ; Parikh, Omi ; Bennamoun, Mostefa and Garcia Freire, Camilo , et al. (2022) In European Urology Open Science 45. p.12-22
Abstract

Background: Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC). Objective: To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. Design, setting, and participants: A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. Intervention: Patients received first- and second-line hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone–radium-223... (More)

Background: Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC). Objective: To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. Design, setting, and participants: A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. Intervention: Patients received first- and second-line hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone–radium-223 (ABI-RAD), docetaxel-abiraterone (DOCE-ABI), docetaxel-cabazitaxel (DOCE-CABA), docetaxel-enzalutamide (DOCE-ENZA), and enzalutamide-docetaxel (ENZA-DOCE). Outcome measurements and statistical analysis: Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively. Results and limitations: Data from 727 patients were eligible for the analysis (ABI-DOCE n = 178, ABI-ENZA n = 99, ABI-RAD n = 27, DOCE-ABI n = 191, DOCE-CABA n = 74, DOCE-ENZA n = 116, and ENZA-DOCE n = 42). Demographics and disease characteristics among patients between different sequences varied greatly. Most patients who started on abiraterone or enzalutamide stopped therapy because of disease progression. No randomisation to allow treatment/sequence comparisons limited this observational study. Conclusions: The real-world PCR data complement clinical trial data, reflecting more highly selected patient populations than seen in routine clinical practice. Baseline characteristics play a role in mCRPC first-line treatment selection, but other factors, such as treatment availability, have an impact. Efficacy observations are limited and should be interpreted with caution. Patient summary: Baseline characteristics appear to have a role in the first-line treatment selection of metastatic castration-resistant prostate cancer in the real-world setting. First-line abiraterone acetate plus prednisone seems to be the preferred treatment option for older patients and those with lower Gleason scores, first-line docetaxel for younger patients and those with more advanced disease, and first-line enzalutamide for patients with fewer metastases and more favourable performance status. The benefit to patients from these observations remains unknown.

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type
Contribution to journal
publication status
published
subject
keywords
Abiraterone acetate, Androgen deprivation therapy, Antiandrogen, Cabazitaxel, Castration-resistant prostate cancer, Docetaxel, Enzalutamide, Ra-223, Real-world evidence
in
European Urology Open Science
volume
45
pages
11 pages
publisher
Elsevier
external identifiers
  • scopus:85138029038
  • pmid:36353661
ISSN
2666-1691
DOI
10.1016/j.euros.2022.08.018
language
English
LU publication?
yes
id
584e9dd4-9a9d-4af2-8c37-2674f5fe9d16
date added to LUP
2022-11-30 13:23:58
date last changed
2024-06-11 20:09:48
@article{584e9dd4-9a9d-4af2-8c37-2674f5fe9d16,
  abstract     = {{<p>Background: Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC). Objective: To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. Design, setting, and participants: A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. Intervention: Patients received first- and second-line hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone–radium-223 (ABI-RAD), docetaxel-abiraterone (DOCE-ABI), docetaxel-cabazitaxel (DOCE-CABA), docetaxel-enzalutamide (DOCE-ENZA), and enzalutamide-docetaxel (ENZA-DOCE). Outcome measurements and statistical analysis: Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively. Results and limitations: Data from 727 patients were eligible for the analysis (ABI-DOCE n = 178, ABI-ENZA n = 99, ABI-RAD n = 27, DOCE-ABI n = 191, DOCE-CABA n = 74, DOCE-ENZA n = 116, and ENZA-DOCE n = 42). Demographics and disease characteristics among patients between different sequences varied greatly. Most patients who started on abiraterone or enzalutamide stopped therapy because of disease progression. No randomisation to allow treatment/sequence comparisons limited this observational study. Conclusions: The real-world PCR data complement clinical trial data, reflecting more highly selected patient populations than seen in routine clinical practice. Baseline characteristics play a role in mCRPC first-line treatment selection, but other factors, such as treatment availability, have an impact. Efficacy observations are limited and should be interpreted with caution. Patient summary: Baseline characteristics appear to have a role in the first-line treatment selection of metastatic castration-resistant prostate cancer in the real-world setting. First-line abiraterone acetate plus prednisone seems to be the preferred treatment option for older patients and those with lower Gleason scores, first-line docetaxel for younger patients and those with more advanced disease, and first-line enzalutamide for patients with fewer metastases and more favourable performance status. The benefit to patients from these observations remains unknown.</p>}},
  author       = {{Bjartell, Anders and Costa, Luis and Kramer, Gero and Zurawski, Bogdan and Galli, Luca and Werbrouck, Patrick and Ecke, Thorsten and Parikh, Omi and Bennamoun, Mostefa and Garcia Freire, Camilo and Peer, Avivit and Ljungberg, Börje and Cicin, Irfan and Smith, Emma and Lukac, Martin and Wapenaar, Robert and Chowdhury, Simon}},
  issn         = {{2666-1691}},
  keywords     = {{Abiraterone acetate; Androgen deprivation therapy; Antiandrogen; Cabazitaxel; Castration-resistant prostate cancer; Docetaxel; Enzalutamide; Ra-223; Real-world evidence}},
  language     = {{eng}},
  pages        = {{12--22}},
  publisher    = {{Elsevier}},
  series       = {{European Urology Open Science}},
  title        = {{Real-world Treatment Sequencing in Patients with Metastatic Castration-resistant Prostate Cancer : Results from the Prospective, International, Observational Prostate Cancer Registry}},
  url          = {{http://dx.doi.org/10.1016/j.euros.2022.08.018}},
  doi          = {{10.1016/j.euros.2022.08.018}},
  volume       = {{45}},
  year         = {{2022}},
}