Assessing Utilization Patterns of mHSPC Treatment in a Community Oncology Practice Setting

An analysis presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium highlighted real-world treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC) who received at least 1 line of therapy in a community oncology practice.

Results showed treatment patterns that diverge from current guideline recommendations.

Traditionally, androgen deprivation therapy (ADT) has been a standard-of-care treatment for mHSPC. However, early use of docetaxel and novel androgen receptor inhibitors (nARIs) has demonstrated improved clinical outcomes.

Sreevalsa Appukkuttan, MBBS, MPH, and colleagues designed a retrospective, observational study of health records from 5 Cancer Treatment Centers of America sites to assess real-world treatment of mHSPC in the community setting. A total of 523 patients who were treated with ADT, docetaxel, or nARIs for at least 6 months from January 2015 to March 2021 were included in the analysis.

Researchers observed treatment patterns from first line of therapy to metastatic castration resistance, death, or lost-to-follow-up until March 2022. Line of therapy was defined as first to last date of active drug therapy, excluding long-term hormone agonists. First line of therapy was defined as initial regimen with no new drugs after at least 30 days from the start date.

After a median follow-up time of 2.9 years, researchers found the most common first line of therapy regimen was either ADT alone or ADT with first-generation ARIs. Forty-six percent of patients received a second line of therapy, and 15% received a third line of therapy. Mean duration of first and second active lines of therapy were 12 and 10 months, respectively.

Researchers noted that among the 65% and 78% patients who discontinued first- and second-line therapy, respectively, the majority discontinued due to progression of disease (35% and 53%, respectively).

“Despite recommendations from guidelines on early intensification of therapy in mHSPC, [we found] that most patients received either ADT alone or ADT plus first-generation ARI [as first-line therapy regimens],” they concluded. “Further studies are needed to assess the factors associated with nonintensification of treatments.”