(UroToday.com) In a moderated poster presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Joyce presented an analysis examining practice patterns in the management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) and with non-metastatic castrate-resistant prostate cancer (nmCRPC).
The treatment landscape in each of these disease spaces has evolved rapidly and now includes many treatment options: docetaxel, abiraterone acetate, enzalutamide, and apalutamide in mHSPC and apalutamide, enzalutamide, and darolutamide in nmCRPC. These agents have similar oncologic benefits are there is little clear guideline consensus on sequencing or specific selection of these agents. Thus, the authors sought to describe contemporary prescribing trends among oncologists and urologists managing mHSPC and nmCRPC.
To do so, they used the IQVIA claims-based dataset, which includes over 17 million cancer patients and 10,000 providers across all 50 United States. In this dataset, they identified all men age 18 and older who received systemic treatment for mHSPC or nmCRPC between 2015 and 2021. They categorized patient’s treatments into 4 groups: novel hormonal (NHT: apalutamide, enzalutamide, darolutamide, abiraterone), 1st generation anti-androgens (AA, such as bicalutamide), LHRH monotherapy, and chemotherapy. Using these categories, the authors assessed treatment patterns for the first 3 treatment lines by year of initiation.
The authors identified 66,846 patients receiving 1st line treatment of whom 63,289 (95.5%) were treated for mHSPC and 3,557 (5.3%) were treated for nmCRPC. Over time, there was a steady increase in the utilization of NHT in both disease spaces: from 20% of treatments in 2018 to 30% in 2021 for mHSPC and from 49% to 82% in nmCRPC. Compared to urologists, oncologists were more likely to prescribe NHT for mHSPC at each time point (36%, n=511, vs 15%, n=104, p<0.001).
However, these differences in between specialties was not observed in the treatment of nmCRPC, in which increases in the utilization of NHT happened in lock step for patients treated by both urologists and oncologists.
Starting in 2018, NHTs accounted for 40-47% and 43-96% of subsequent line treatments in HSPC and nmCRPC, respectively.
Interestingly, the authors found that a significant proportion of men with mHSPC received prolonged durations of first-generation anti-androgen.
The authors conclude that, since their approval by the FDA in 2018, NHT for mHSPC and nmCRPC has steadily increased but still remains underutilized.
Presented by: Daniel Joyce, MD, Mayo Clinic, Rochester, MN