(UroToday.com) The 2023 GU ASCO annual meeting included a session on prostate cancer, featuring a presentation by Dr. Samuel Washington discussing geographic variation in utilization of doublet therapy for metastatic prostate cancer. Clinical trials for men with metastatic prostate cancer have supported the use of combination therapies to improve survival outcomes, with recent work showing increased benefit of triplet regimens.1 However, real-world utilization of doublet therapy (i.e., ADT plus a novel hormonal therapy) and variation in use according to geographic region have not been evaluated in detail. With recent data supporting the use of triplet regimens there is a need for further understanding of what factors already impact doublet therapy utilization before we can intensify treatment further. Using data aggregated from a national cohort of community and academic medical oncology practices, Dr. Washington and colleagues characterized real-world utilization of doublet therapy and examined factors associated with its use, including geographic region.
Using ConcertAI RWD, clinical data of men with metastatic prostate cancer was linked with state-level measures of socioeconomic factors and healthcare resources from the Area Health Resources File. Logistic regression was used to evaluate associations between clinical and community characteristics and receipt of doublet therapy (vs ADT alone) within 90 days of diagnosis. Models were adjusted for clinical factors, state level factors (excluding hospital beds, poverty, and education due to collinearity), and geographic region.
A total of 1,763 men with M1 disease were eligible, with a mean age of 68.6 years at diagnosis. Nearly half (48%) of the men lived in the Southern region, 9.3% in the North East, 18.6% in the West, and 23.7% in the Midwest. Roughly 13.8% were Black, 1.3% American Indian, and 1.1% Asian. One-third received ADT alone (37.8%). Regression analysis for ADT + novel hormonal therapy versus ADT included 1,604 men, of which 84.6% received doublet therapy. Geographic region [vs Southern: Midwest OR 0.60, 95% CI 0.40-0.90; Northeast OR 0.40, 95% CI 0.20-0.70], larger state population [(log-transformed) OR 0.09, 95 % 0.02-0.30], prior surgery or radiation (vs none, OR 1.70, 95% CI 1.30-2.30), greater urologist density [(log-transformed), OR 0.10, 95% CI 0.02-0.80] and radiation oncologist density [(log-transformed), OR 12.9, 95% CI 2.80-60.2] were significantly associated with receipt of doublet therapy compared to ADT alone.
Dr. Washington concluded his presentation by discussing geographic variation in utilization of doublet therapy for metastatic prostate cancer with the following concluding messages:
- Receipt of doublet therapy was impacted by geographic region and regional availability of specialty care (i.e. urologist and radiation oncologist density), emphasizing the relationship between regional medical expertise and care implementation
- As the drive to improve care grows, this study highlights how treatment remains influenced by where you live and the need for identifying actionable targets for intervention and organizational change at the regional level
Presented by: Samuel L. Washington, MD, UCSF Department of Urology, San Francisco, CA
Co-Authors: Janet E. Cowan, Shoujun Zhao, Jennifer Rider, Nicholas Taylor, Warren Whyte, Peter Carroll, Matthew R. Cooperberg
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 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.
References:
- Smith MR, Hussain M, Saad F, et al. Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer. N Engl J Med. 2022 Mar 24;386(12):1132-1142.