Systematic Literature Review of the Epidemiology of Advanced Prostate Cancer and Associated HRR Gene Alterations.

To characterize the global epidemiology of metastatic castration-sensitive prostate cancer (mCSPC), non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC). Additionally, to assess the prevalence of homologous recombination repair gene alterations (HRRm) and their prognostic impact in advanced disease setting.

A systematic literature review of real-world evidence (RWE) published 01/2009-05/2019 was conducted to assess global epidemiology and clinical practice trends for mCSPC, nmCRPC, mCRPC and HRRm. 4,732 papers were systematically screened for inclusion. Ten conference proceedings from 2014-2019 were reviewed.

22 relevant publications were identified for this paper. Six publications reported global epidemiology of advanced prostate cancer (PC). The prevalence of nmCRPC was estimated as 1.1-12.3% of PC cases and for mCRPC was 1.2-2.1% of PC cases. No mCSPC prevalence was captured. Sixteen publications investigated HRRm prevalence in advanced PC with the majority conducted in mCRPC assessed using next-generation sequencing of tissue and germline samples. In mCRPC, the highest prevalence HRRm in both germline (3.3-6.0%) and somatic (5.0-15.1%) was BRCA2. Five publications reported the prognostic impact of HRRm in advanced PC.

Published RWE quantifying the prevalence of advanced PC and HRRm beyond mCRPC is sparse. Published data on HRRm, specifically BRCA2, are consistent with published clinical trial data for poly (ADP-ribose) polymerase inhibitors in mCRPC. In mCRPC, RWE suggest that HRRm patients have different clinical outcomes to non-carriers. More data are needed to better understand real-world patient segmentation and clinical outcomes for biomarkers given increasing interest in profiling.

The Journal of urology. 2020 Dec 17 [Epub ahead of print]

N Shore, L Oliver, I Shui, A Gayle, O Y Wong, J Kim, S Payne, S Amin, S Ghate

Carolina Urologic Research Center, Myrtle Beach, South Carolina., Adelphi Values PROVE, Manchester, UK., Merck & Co. , Inc., Kenilworth, New Jersey., AstraZeneca , Cambridge, UK.