Real-world outcomes of second novel hormonal therapy or radium-223 following first novel hormonal therapy for mCRPC.

Aim: To evaluate real-world clinical outcomes of radium-223 or alternative novel hormonal therapy (NHT) following first-line NHT for metastatic castration-resistant prostate cancer (mCRPC). Patients & methods: Retrospective analysis of the US Flatiron database (ClinicalTrials. gov identifier: NCT03896984). Results: In the radium-223 cohort (n = 120) versus the alternative NHT cohort (n = 226), proportionally more patients had prior symptomatic skeletal events and bone-only metastases, and first-line NHT duration was shorter. Following second-line therapy, 49 versus 39% of patients received subsequent life-prolonging therapy; of these, 47 versus 76% received taxane. Median overall survival was 10.8 versus 11.2 months. Conclusion: Real-world patients with mCRPC had similar median overall survival following second-line radium-223 or alternative NHT after first-line NHT. Many patients received subsequent therapy, with less taxane use after radium-223.

Lay abstract Patients with metastatic castration-resistant prostate cancer are often first treated with novel hormonal therapy (NHT) using abiraterone or enzalutamide. To aid decisions about what treatment to use next, we reviewed information about patients who were treated with an alternative NHT (226 patients) or the nuclear medicine radium-223 (120 patients) after the first NHT. Most patients given radium-223 had cancer that had spread to their bones only, whereas many patients given an alternative NHT had cancer in their bones and other parts of their body. Around one in four patients given radium-223 and one in five given an alternative NHT had symptoms related to their bone metastases after starting treatment. Five in every ten patients given radium-223 received further therapy, including chemotherapy in 50% of these patients, while four in every ten patients given an alternative NHT received further therapy, including chemotherapy in 75%. On average, patients lived for almost a year after starting radium-223 or an alternative NHT.

Future oncology (London, England). 2021 Oct 12 [Epub ahead of print]

Oliver Sartor, Daniel George, Bertrand Tombal, Neeraj Agarwal, Celestia S Higano, Cora N Sternberg, Kurt Miller, XiaoLong Jiao, Helen Guo, Per Sandström, Amanda Bruno, Frank Verholen, Fred Saad, Neal Shore

Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA., Departments of Medicine & Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA., Division of Urology, IREC, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium., Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Department of Medicine, University of Washington & Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Englander Institute for Precision Medicine, Weill Cornell Department of Medicine, Meyer Cancer Center, New York-Presbyterian Hospital, New York, NY, USA., Charité - Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany., Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA., Bayer Consumer Care AG, Basel, Switzerland., University of Montreal Hospital Center, Montreal, Quebec, Canada., Carolina Urologic Research Center, Myrtle Beach, SC, USA.

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