Real-world treatment patterns in metastatic castration-resistant prostate cancer progressing from metastatic hormone-sensitive prostate cancer.

OBJECTIVE

To examine how changes in metastatic hormone-sensitive prostate cancer (mHSPC) management (e.g. approval of androgen receptor pathway inhibitors [ARPIs] ± docetaxel in combination with androgen deprivation therapy [ADT]) may be impacting metastatic castration-resistant prostate cancer (mCRPC) treatment patterns.

METHODS

This retrospective, observational study analyzed private insurance claims data from the US Komodo Health Healthcare Map database to identify people diagnosed with mCRPC between 1 January 2020 to 31 March 2023, after progressing from mHSPC. Analyses included treatment patterns for mCRPC by line of therapy, with stratification by prior mHSPC therapy and physician specialty.

RESULTS

A total of 3,151 people with mCRPC were identified. Median age was 67 years, 46% had bone-only metastases and 31% had bone + visceral metastases; 64% were treated by oncologists and 10% by urologists. Previous treatment for mHSPC included ADT only (68%), ADT + docetaxel (13%), ADT + abiraterone (8%), or ADT + non-abiraterone ARPI (11%; i.e. enzalutamide, apalutamide, or darolutamide). The most common first-line treatment for mCRPC was abiraterone in people who had received ADT alone or ADT + docetaxel for mHSPC (48% each) and chemotherapy in people who had received ADT + abiraterone or ADT + non-abiraterone ARPI for mHSPC (46% and 37%, respectively). mCRPC treatment patterns were heavily influenced by prescribing physician specialty, with oncologists more likely than urologists to prescribe abiraterone, chemotherapy or radiopharmaceuticals, and urologists more likely to prescribe non-abiraterone ARPIs.

CONCLUSION

Despite changes in mHSPC management, ARPIs remain a frequent choice of first-line mCRPC therapy, with back-to-back ARPI use common. Even with the availability of other therapies beyond ARPIs, and the clinical evidence supporting use of agents beyond ARPIs, treatment with these therapies was limited.