(UroToday.com) The 2023 AUA annual meeting included an advanced prostate cancer session, featuring a presentation by Dr. Joseph Black discussing prescription patterns of systemic therapy in the management of metastatic castration-sensitive prostate cancer (mCSPC). Although ADT remains the backbone treatment for patients with mCSPC, multiple randomized studies since 2015 have demonstrated that treatment intensification with the addition of taxanes and/or novel hormonal therapies confers significantly improved overall survival. This adds complexity for providers with developing an individual therapeutic approach for patients with mCSPC. Furthermore, provider prescription patterns for mCSPC are heterogeneous, which may present barriers for patients in receiving newer interventions. To investigate this, Dr. Black and colleagues conducted a retrospective analysis on the prescription utilization patterns of clinicians initiating treatment for patients with mCSPC.
For this study, pharmacy and claims data were queried from 2015-2022 to identify patients with prostate cancer. The IQVIA Anonymized Patient Longitudinal dataset includes 18 million US cancer patients, including Medicaid, Medicare, Medicare Part D, and cash transactions. Patients with mCSPC were identified using at minimum two ICD 9/10 diagnosis codes and/or medications on separate days. Drug classes analyzed include novel hormonal therapies, first-generation anti-androgens, chemotherapy, and LHRH monotherapy. Prescription rates of each class of drug were stratified by patient and provider baseline characteristics.
Novel hormonal therapy prescription has increased, while chemotherapy, first generation anti-androgens, and LHRH monotherapy have either remained unchanged or decreased since 2015:
No variation in prescription patterns were observed between urban and rural settings:
Medical oncologists were more likely to prescribe novel hormonal therapies than urologists (45% vs. 19%), whereas urologists were more likely to prescribe LHRH monotherapy (69% vs 38%):
Dr. Black concluded his presentation discussing prescription patterns of systemic therapy in the management of mCSPC by highlighting the following take-home messages:
- Since 2015, novel hormonal therapy utilization and treatment intensification has nationally increased for mCSPC and prescription patterns do not vary between rural and urban settings
- When compared to urologists, medical oncologists have more readily incorporated newer therapeutics for mCSPC and decreased the usage of LHRH monotherapy for patients with mCSPC
- These data represent a potential area for growth for urologists in the treatment of mCSPC
Presented by: Joseph Black, MD, PhD, Beth Israel Deaconess Medical Center, Boston, MA
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 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023