(UroToday.com) The 2023 AUA annual meeting included an advanced prostate cancer session, featuring a presentation by Dr. Neal Shore discussing treatment patterns and health-related quality of life of patients with metastatic castration resistant prostate cancer (mCRPC) in the US. Therapeutic advances in the management of mCRPC have given clinicians multiple treatment options and the potential for sequencing therapeutic agents, increasing the complexity of treatment decisions. This study aimed to describe the treatment patterns and HRQoL of patients with mCRPC in the US from 2015 to 2021.
This prospective, observational, multicenter study (TRUMPET) enrolled male adult patients who initiated treatment for mCRPC from 147 urology and oncology sites in the US. The data from routine clinic visits and periodic HRQoL questionnaires were collected from March 2015 to April 2021. The study outcomes assessed patterns of care and HRQoL outcomes (Functional Assessment of Cancer Therapy-Prostate [FACT-P] and Brief Pain Inventory Short Form [BPI-SF]) associated with mCRPC management. Descriptive analyses were used to evaluate results.
Among the enrolled patients, the full analysis set included 832 patients with M1 mCRPC and the safety analysis set included 869 patients with M1 mCRPC. The median duration from initial diagnosis to baseline visit was 4.9 years, median initial PSA level at diagnosis was 16.3 ng/mL, and mean Gleason score was 8.0 (SD 1.18). Novel hormonal therapy (enzalutamide and/or abiraterone) and immunotherapy were the most frequent initial treatments:
During the follow-up period, 43.8% (n = 381) discontinued from the study before the first treatment switch, while 50.1% (n = 435) switched treatment, with the majority of patients switching to novel hormonal therapy (n = 280, 32.2%):
At 1 year follow-up, cumulative first switches were 128 of 158 (81%) from immunotherapy to novel hormonal therapy, 41 of 88 (47%) switched from novel hormonal therapy to a different novel hormonal therapy, 11 of 17 (65%) switched from first-generation anti-androgens to novel hormonal therapy, 19 of 26 (73%) switched from chemotherapy to novel hormonal therapy, and 6 of 11 (55%) switched from radionuclide therapy to novel hormonal therapy:
HRQoL measures showed similar trends (overlapping confidence intervals) of mean change from baseline across different first-line treatment options, irrespective of the initial treatment:
Dr. Shore concluded his presentation discussing treatment patterns and health-related quality of life of patients with mCRPC in the US with the following take-home messages:
- Novel hormonal therapy was the most commonly used first-line treatment option for patients with mCRPC, followed by immunotherapy
- Novel hormonal therapy was the preferred second-line treatment option for patients with mCRPC, irrespective of the initial treatment
- FACT-P and BPI-SF showed similar trends of mean change from baseline, irrespective of initial treatment
Presented by: Neal D. Shore, MD, FACS, Medical Director, Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023