Real-world Treatment Sequencing in Patients with Metastatic Castration-resistant Prostate Cancer: Results from the Prospective, International, Observational Prostate Cancer Registry.
Eur Urol Open Sci
; 45: 12-22, 2022 Nov.
Article
em En
| MEDLINE
| ID: mdl-36353661
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 andparticipants:
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 statisticalanalysis:
Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively. Results andlimitations:
Data from 727 patients were eligible for the analysis (ABI-DOCE nâ¯=â¯178, ABI-ENZA nâ¯=â¯99, ABI-RAD nâ¯=â¯27, DOCE-ABI nâ¯=â¯191, DOCE-CABA nâ¯=â¯74, DOCE-ENZA nâ¯=â¯116, and ENZA-DOCE nâ¯=â¯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. Patientsummary:
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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Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Observational_studies
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article