ASCO 2021: Real-World Utilization of Advanced Therapies and Racial Disparity Among Patients with Metastatic Castration-Sensitive Prostate Cancer: A Medicare Database Analysis

( One of the fastest moving disease spaces in prostate cancer is metastatic castration-sensitive prostate cancer. While androgen-deprivation therapy (ADT) alone was the standard treatment five years ago, now there are a number of treatment options that have been shown to improve overall survival, including docetaxel and novel hormonal therapies including abiraterone acetate, enzalutamide, and apalutamide. While these agents have proven benefit in clinical trials, improvement in population-level outcomes depends on their wide-spread adoption. In the Prostate, Testicular, Penile Poster session at the 2021 American Society of Clinical Oncology (ASCO) 2021 Annual Meeting held on Friday June 4th, 2021, Dr. Freedland presented results of an analysis of Medicare data regarding real-world utilization of these agents in men with mCSPC.

The authors performed a retrospective analysis of a Medicare database on the basis of claims between January 2009 and December 2018. They identified adult men with ≥1 claim for prostate cancer (PC) who initiated ADT (index date) within 90 days prior to or any time after a metastasis diagnosis.


Patients were categorized according to first-line treatment based on medications prescribed within 30 days prior to and 120 days after the index date. These categories included: ADT alone, ADT + first-generation anti-androgen (≥90 days to avoid capturing AA for flare control), ADT + docetaxel, and ADT + novel hormonal therapy (abiraterone, apalutamide, and enzalutamide). The authors further characterized first-line treatment distributions over time and stratified by race.

The authors identified 35,195 patients with mCSPC who were included in the study. The mean (SD) age of the study cohort was 76.5 (7.9) years. Further, the majority (78.5%) were White, while 11.8% were Black and 5.3% were Hispanic.


The vast majority of men (76.4%) received ADT alone as first-line treatment, while 14.3% receiving ADT + first-generation anti-androgen, 4.8% received ADT + docetaxel, and 4.5% received ADT + novel hormonal therapy.

The authors found slowly decreasing utilization of ADT alone and ADT + first-generation anti-androgen over time with increasing utilization of ADT + docetaxel (since 2015) and ADT + novel hormonal therapies (since 2017). However, even as of 2018, ADT alone remained the most commonly utilized treatment approach.

They further found that, stratified by race, use of ADT + novel hormonal therapies was less common among Black (aOR 0.60, 95% CI 0.52-0.70) and Hispanic (aOR 0.68, 95% CI 0.55-0.85) men, relative to White, non-Hispanic men.


The authors conclude that, based on this large and nationally representative sample of men with mCSPC patients, treatment intensification was uncommonly used with some, but not dramatic, an improvement over time. Importantly, they further showed that treatment intensification was less commonly used in Black and Hispanic patients.

Presented by: Stephen J. Freedland, MD, director of the Center for Integrated Research in Cancer and Lifestyle and co-director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Faculty physician in the Division of Urology within the Department of Surgery at Cedars-Sinai.

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Contact: @WallisCJD on Twitter at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, Virtual Annual Meeting #ASCO21, June, 4-8, 2021