(UroToday.com) The 2025 ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Stephen Freedland discussing treatment patterns and survival by race among men with metastatic castration-resistant prostate cancer (mCRPC) in the United States.
Given the potential shift of androgen receptor pathway inhibitors/docetaxel use to earlier disease states of metastatic hormone-sensitive prostate cancer (mHSPC), very little is known regarding the impact of these changes on the management and survival in the later state of mCRPC, especially within racial minorities. As such, Dr. Freedland and colleagues examined treatment utilization and survival outcomes by race among patients with mCRPC within the United States.
This was a retrospective cohort of patients treated for mCRPC between 2020-2023 identified in the ConcertAI NLP360 oncology electronic medical records (EMR) database, which includes data from 900+ US oncology centers. Evidence of CRPC and being previously diagnosed with mHSPC was confirmed through a clinical algorithm. Continuous EMR activity for ≥12 months pre-mCRPC and ≥6 months post-mCRPC was required to capture baseline characteristics and outcomes. Line of therapy was identified as androgen receptor pathway inhibitors, chemotherapy, PARP inhibitors, immunotherapy (pembrolizumab, sipuleucel-T), radiopharmaceuticals (Radium-223, 177Lu-PSMA-RLT), alone or in combination.
Of 609 patients, 456 (75%) were white, 88 (14%) African-American, and 65 (11%) other races, with a median age of 72 years (IQR 66-79). Nearly 85% had ECOG 0-1, 79% had bone metastases, and 42% received bone-health agents during baseline. Most patients received ADT alone for mHSPC (53%), followed by ADT + androgen receptor pathway inhibitors (37%) and ADT + docetaxel (10%). Except for a higher use of bone-health agents at baseline in whites (43% versus 31%), there were no significant differences in baseline clinical and treatment characteristics by race. Overall, androgen receptor pathway inhibitors (62%) [abiraterone: 25%; enzalutamide: 24%; apalutamide: 9%; darolutamide 4%] and chemotherapy (22%) [docetaxel 16%; cabazitaxel 6%] were the most common first-line treatments for mCRPC. This trend was consistent by race except for a marginal higher use of androgen receptor pathway inhibitors and lower use of chemotherapy among African-Americans versus Whites:
The median real-world overall survival from first-line mCRPC treatment was 21 months (95% CI 18, 25) with no significant difference across the race groups.
Dr. Freedland concluded his presentation discussing treatment patterns and survival by race among men with mCRPC in the United States with the following take-home points:
- Androgen receptor pathway inhibitors and chemotherapy remained the most utilized therapies in mCRPC from 2020 to 2023 in the United States
- Treatment and survival outcomes did not differ significantly between whites and African-Americans in mCRPC
Presented by: Stephen J. Freedland, MD, Urologist, Director of the Center for Integrated Research in Cancer and Lifestyle, Associate Director for Training and Education at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinari, Los Angeles, CA
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the American Society of Clinical Oncology (ASCO) 2025 Annual Meeting, Chicago, IL, Fri, May 30 – Tues, Jun 3, 2025.