Clinical trials have demonstrated the efficacy of several life-prolonging therapies for metastatic castration-resistant prostate cancer (mCRPC); however, real-world data on their use, survival effect, and safety are limited. Using electronic health record data from the Flatiron Health database, we studied real-world treatment patterns and health outcomes in patients with mCRPC.
We conducted a retrospective, non-interventional cohort analysis of electronic health record data of patients with confirmed mCRPC between January 2013 and September 2017. The primary objective was to describe real-world treatment patterns, including treatment type, duration, and sequencing. Secondary objectives included describing patient characteristics and clinical outcomes.
Of 2559 patients with mCRPC, 1980 (77%) received at least 1 line of life-prolonging therapy (abiraterone, enzalutamide, docetaxel, cabazitaxel, sipuleucel-T, or radium-223). Of patients receiving first-line therapy, 49% received second-line therapy, and of these, 43% received third-line therapy. Abiraterone/prednisone and enzalutamide accounted for 65% of first-line therapies and 54% of second-line therapies. Docetaxel was the most common third-line therapy (24%). Back-to-back use of abiraterone/prednisone and enzalutamide was common. Radium-223 monotherapy use was 2% in the first-line setting, 3% in the second-line setting, and 8% in the third-line setting. The median overall survival was longer in patients who received life-prolonging therapies (23.7 months; 95% confidence interval: 22.3-25.1 months) than in those who did not (10.1 months; 95% confidence interval: 9.1-11.5 months).
These real-world insights on over 2500 patients with mCRPC supplement findings from randomized controlled trials and may help to inform clinical trial design, treatment guidelines, and clinical decision-making.
Clinical genitourinary cancer. 2020 Jan 07 [Epub ahead of print]
Daniel J George, Oliver Sartor, Kurt Miller, Fred Saad, Bertrand Tombal, Ján Kalinovský, Xiaolong Jiao, Krishna Tangirala, Cora N Sternberg, Celestia S Higano
Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC. Electronic address: ., Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA., Charité Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany., University of Montréal Hospital Centre, Montréal, Quebec, Canada., Division of Urology, Institute of Experimental and Clinical Research, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium., Bayer Consumer Care AG, Basel, Switzerland., Bayer HealthCare Pharmaceuticals, Whippany, NJ., Weill Cornell Department of Medicine, New York-Presbyterian Hospital, New York, NY., Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA.