(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on advanced prostate cancer and a presentation by Dr. David Gangwish discussing an analysis of discontinuation rates and causes of early discontinuation of novel oral hormone therapy in men with advanced prostate cancer. Prostate cancer is the second most common cause of cancer-specific death in US men. Novel oral hormone therapy significantly prolongs survival and maintains quality of life in advanced prostate cancer patients. Despite known benefits, these medications are commonly discontinued. This study evaluated the prevalence of early discontinuation of novel hormone therapy, the determinants of early discontinuation and the effect of changing novel hormone therapy on duration of treatment.
This study was a retrospective cohort study of 333 patients with advanced prostate cancer who started a novel hormone therapy in a single community urology practice in the United States between February 2016 and July 2020. Novel hormone therapy medication, start date of treatment, reason for discontinuation, and discontinuation date were collected. Additional data included demographics, stage of prostate cancer, PSA at time of novel hormone therapy initiation, Gleason score, and prior prostate cancer treatments. The cohort was divided into 2 subgroups: Group A - those did not change medication, and Group B - those that did change to a different novel hormone therapy. Student’s t-test, Chi-square test, and Kaplan-Meier survival analysis were carried out to determine significant differences between groups.
At one year, 28.8% of patients had early discontinuation of novel hormone therapy. The most common reasons for discontinuation were side effects (fatigue 45%; dizziness/confusion 14%, diarrhea 11%, elevated liver enzymes 7%) and death at 34.4% each. Group A (282 patients) and Group B (51 patients) discontinued treatment at a rate of 31% and 88%, respectively. Primary reasons for discontinuation in group A versus group B was due to side effects (36% vs 47%) or cancer progression (34% vs 49%). More patients in group B were deceased than in group A (58.8% vs 29.4%). Of those that discontinued novel hormone therapy, patients remained on treatment for an average of 382 days in group A versus 593 days in group B (Kaplan-Meier analysis p = 0.003):
In group B, patients on average discontinued first novel hormone therapy after 330 days and continued secondary novel hormone therapy for an additional 263 days.
Dr. Gangwish concluded his presentation discussing an analysis of discontinuation rates and causes of early discontinuation of novel oral hormone therapy in men with advanced prostate cancer:
- Side effects and cancer progression were the main reasons for discontinuing novel hormone therapy treatment
- Providing patients with alternative novel hormone therapy significantly increases the duration of treatment
- It is important for clinicians to understand the causes of early discontinuation to develop strategies to maximize duration of therapy for management of advanced prostate cancer
Presented by: David Gangwish, MD, Beaumont Michigan Institute of Urology, Troy, MI
Co-Authors: Bernadette Zwaans, Royal Oak, MI; Paul Miriani, Wesley Dejoie, Andrina Ajo, Connor Ervin, Jeff Sarazin, Jason Hafron, Troy, MI
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.