Real world treatment utilization patterns in patients with castration-resistant prostate cancer

Abstract

Background

Studies describing treatment utilization for castration-resistant prostate cancer (CRPC) are limited. We aimed to describe the treatment utilization of a contemporary population-based CRPC cohort between 2006 and 2016.

Methods

We identified 1699 men with a PC diagnosis between 2005 and 2015, who developed CRPC between 2006 and 2015 in the Stockholm region of Sweden. Demographic information, stage and grade at PC diagnosis, stage at CRPC, prostate-specific antigen (PSA) nadir, PSA doubling time, treatment utilization rate within 1 year of CRPC diagnosis, reason for stopping therapy, treatment sequence trajectory, overall and PC specific survival was described.

Results

Treatment for men with de novo metastatic disease (n = 463) was 32%, treatment for men with progressive metastatic disease after PC diagnosis (n = 66) was 44%, treatment for men with nonmetastatic CRPC (n = 113) was 34% and treatment for those with an unknown stage at time of CRPC diagnosis (n = 857) was 12%. Docetaxel was used in 39%, abiraterone acetate plus prednisone in 15%, enzalutamide in 13%, cabazitaxel in 11% and radium-223 in 5% of treatments. Treatment increased from 22% in 2006–2009 for metastatic cancer to 50% in 2013–2015 (p < .001). Factors associated with treatment were an unknown stage at diagnosis (OR: 0.3, 95% CI: 0.2–0.4), age ≥75 years (OR: 0.2, 95% CI: 0.1 − 0.3), PSA doubling time >3 months (OR: 0.4, 95% CI: 0.3 − 0.6) and a diagnosis between 2013 and 2015 (OR: 3.4, 95% CI: 2.0 − 5.8).

Conclusions

Despite treatment availability, in this large real-world cohort we found treatment utilization to remain low.

Keywords:

• Castration-resistant prostate cancer
• overall survival
• chemotherapy
• systemic therapy
• androgen receptor therapy

Disclosure statement

Level, Dearden, Liwing, Mehra and Nair are employees of Janssen. Schain is a former employee of Janssen and an owner and employed by Schain Research (a consultancy service related to studies for Janssen).

Additional information

Funding

This study was funded via the public–private real-world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals [contract: 5-63/2015]. Additional grant funding: Swedish Research Council [2019-01466] and Swedish Cancer Society [CAN 2018/741].