Real-world use of systemic therapies in men with metastatic castration resistant prostate cancer (mCRPC) in Canada |
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| Institution: | 1. St. Joseph''s Healthcare, McMaster University, Hamilton, ON, Canada;2. Department of Urology, Vanderbilt University Medical Center, Nashville, TN;3. Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada;4. The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;5. Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada;6. Jewish General Hospital, McGill University, Montreal, QC, Canada;7. Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada;8. Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada;9. London Health Sciences Centre, Western University, London, ON, Canada;10. BC Cancer Agency, University of British Columbia, Surrey, BC, Canada;11. Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada;12. Medical Affairs, Janssen Inc, Toronto, ON, Canada;13. Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada;14. Centre Hospitalier de l''Université de Montréal, University of Montreal, Montreal, QC, Canada |
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| Abstract: | BackgroundManagement of advanced prostate cancer has evolved rapidly with the availability of multiple systemic treatments such as androgen-receptor axis-targeted therapies (ARATs), taxane-based chemotherapy, radium-223, and other approaches. However, limited data exists on real-world treatment selection and clinical outcomes. This study examines the utilization and survival impact of these therapies in men with metastatic castration-resistant prostate cancer (mCRPC) in the real-world setting of Ontario, Canada.MethodsThis study was a retrospective, longitudinal, population-based study of administrative claims data between January 2016 and April 2020. Men ≥ 66 years with mCRPC receiving advanced treatment were included. Patients were indexed on the day they initiated mCRPC treatment and followed up until death or end of study period to assess treatment and survival. Multinomial regression was used to model the association between baseline covariates, treatment and survival.ResultsMedian age was 75 years among the 944 mCRPC patients who received life-prolonging therapies during this time period. Over 90% of patients used an ARAT as a first-line therapy, and 71.5% received only first-line therapy before death or censoring. Of patients that received two or more lines, over 80% received subsequent therapy with a different mechanism of action. Median overall survival was 18.9 months.ConclusionsARATs have become the predominant first-line systemic treatment option for mCRPC patients in recent years. Notably, the majority of patients received only a single line of life-prolonging therapy after developing mCRPC. In keeping with the recognized efficacy-effectiveness gap, real-world outcomes in this cohort appear poorer than in clinical trials. |
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