ASCO 2021: Real-World First-Line Treatment Patterns in Patients with Metastatic Castration-Sensitive Prostate Cancer in a U.S. Health Insurance Database

( One of the fastest moving disease spaces in prostate cancer in 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) Annual Meeting, Dr. Umang Swami and colleagues assessed the real-world utilization of effective combination therapies as first-line treatment in insured patients in the U.S. with mCSPC.

To do so, the authors performed a retrospective study of the Optum health insurance claims database, which includes patients claims data from both commercially insured and Medicare Advantage populations. They included adult men with ≥1 claim with a metastatic International Classification of Diseases diagnostic code (first claim was index date) within 90 days prior to, or any time after, a prostate cancer diagnosis between January 2014 and June 2019. However, patients with evidence of systemic anticancer therapy during the 1-year pre-index baseline period were excluded, unless the first drug claim occurred within 90 days prior to the diagnosis of metastatic disease.


The authors assessed first-line treatments which began within 90 days preceding index and 180 days following first treatment. Among treatment received during this period, patients were categorized according to treatment as follows: ADT only; ADT + first-generation antiandrogens (AA); ADT + docetaxel; ADT + novel hormonal therapies; and ADT + novel hormonal therapy + docetaxel.

The authors identified 4221 men with mCSPC, of whom the majority (n=2364, 56.0%) received ADT only. Of the remaining patients, 892 (21.1%) received ADT + first-generation antiandrogens, 577 (13.7%) receiving ADT + novel hormonal therapies, 348 (8.2%) received ADT + docetaxel, and 40 (0.9%) received ADT + novel hormonal therapies + docetaxel. Patients treated with docetaxel, whether in combination with ADT or with novel hormonal therapies and ADT were generally younger than those who received other treatment approaches.


Assessed over time, utilization of ADT alone and ADT + first-generation antiandrogens decreased though ADT alone remained the most common approach (and accounted for more than half of all treated patients) as of 2019. This was true even among men with visceral disease who have the most aggressive disease biology.


The authors demonstrated that real-world utilization of treatment approaches that have been shown to improve survival in men with mCSPC is generally poor, even as of 2019. While further work is needed to understand the reasons for the underutilization of proven life-prolonging therapy, increased efforts are needed to disseminate these therapies to patients.

Presented by: Umang Swami, MD, Department of Oncology, Huntsman Cancer Institute,  Salt Lake City, UT

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