Treatment Patterns Among Androgen Receptor Pathway Inhibitor-Experienced Patients With Metastatic Castration-Resistant Prostate Cancer: A Global Real-World Study.

INTRODUCTION

Androgen receptor pathway inhibitors (ARPIs) are increasingly used earlier in the treatment sequence for prostate cancer. Contemporary real-world treatment patterns post-ARPI are unclear, especially following ARPI use in premetastatic castration-resistant prostate cancer (mCRPC) settings. This study describes contemporary treatment patterns among ARPI-experienced patients with mCRPC across the United States, France, Germany, Italy, Spain, United Kingdom, and Japan.

PATIENTS AND

METHODS

In this retrospective noninterventional study, recruited physicians completed electronic case reports from August-October 2023 based on medical records of adult patients who had received ≥ 1 prior ARPI and ≥ 1 systemic mCRPC therapy. Treatment patterns were summarized. First treatment for mCRPC in ARPI-experienced patients was defined as the index line.

RESULTS

In total, 1014 patients (mean [SD] age at index therapy inception, 69.1 [8.5] years) were included. Initial ARPI was received in pre-mCRPC settings in 82.6% patients and as first-line mCRPC treatment in 17.4%. As index line, most patients received another (sequential) ARPI (48.4%) or docetaxel (35%). Most common sequences from preindex to index therapy were abiraterone→docetaxel (16.1%) and abiraterone→enzalutamide (10.9%). Patients with ECOG score 0-1 more commonly received taxane therapy (42%-46%) than those with ECOG score ≥ 2 (29%).

CONCLUSION

Sequential ARPI use despite disease progression on a prior ARPI remains a common international practice, potentially to avoid chemotherapy-related toxicity. Sequential ARPI versus chemotherapy choice varies by patient performance status, potentially reflecting the role of patient fitness and preference in post-ARPI treatment selection. This study emphasizes the need for alternative therapies in the ARPI-refractory setting.