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Clin Genitourin Cancer. 2020 Jan 7. pii: S1558-7673(19)30392-1. doi: 10.1016/j.clgc.2019.12.019. [Epub ahead of print]

Treatment Patterns and Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer in a Real-world Clinical Practice Setting in the United States.

Author information

1
Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC. Electronic address: daniel.george@duke.edu.
2
Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA.
3
Charité Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany.
4
University of Montréal Hospital Centre, Montréal, Quebec, Canada.
5
Division of Urology, Institute of Experimental and Clinical Research, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
6
Bayer Consumer Care AG, Basel, Switzerland.
7
Bayer HealthCare Pharmaceuticals, Whippany, NJ.
8
Weill Cornell Department of Medicine, New York-Presbyterian Hospital, New York, NY.
9
Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA.

Abstract

BACKGROUND:

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.

PATIENTS AND METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

KEYWORDS:

Community practice; Database; Electronic health record; Flatiron Health; Retrospective study

PMID:
32057714
DOI:
10.1016/j.clgc.2019.12.019

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