Butler Anne M, Cetin Karynsa, Hernandez Rohini K, Diane Reams B, Overman Robert A, I Kim Jung, Hirsch Bradford R, Abernethy Amy P, Liede Alexander, Alan Brookhart M
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
Amgen, Inc., Thousand Oaks and South San Francisco, CA, USA.
Pharmacoepidemiol Drug Saf. 2018 Feb;27(2):229-238. doi: 10.1002/pds.4360. Epub 2018 Jan 7.
To examine the dynamics of treatment with 2 bone-targeting agents (BTAs)-denosumab and zoledronic acid-among men with bone metastases from prostate cancer.
Using electronic health record data from oncology practices across the US, we identified prostate cancer patients diagnosed with bone metastasis in 2012/2013 without evidence of BTA use within 6 months prior to diagnosis. We examined the risk and predictors of BTA initiation, interruption, and re-initiation.
Among 897 men diagnosed with prostate cancer, the cumulative incidence of BTA initiation after bone metastasis diagnosis was 34% (95% confidence interval [CI], 31-37%) at 30 days, 64% (95% CI, 61-68%) at 180 days, and 88% (95% CI, 85-91%) at 2 years. Denosumab was initiated more frequently than zoledronic acid. Men with diabetes, more bone lesions, history of androgen deprivation therapy, or no hospice enrollment were more likely to initiate treatment. Following initiation, the cumulative incidence of treatment interruption was 17% (95% CI, 14-19%) at 60 days and 70% (95% CI, 66-74%) at 2 years, with interruption more likely among patients receiving emerging therapies for prostate cancer or enrolling in hospice. The cumulative incidence of re-initiation following interruption was 36.3% (95% CI, 32.7-40.2%) at 15 days, 49.8% (95% CI, 45.9-54.1%) at 30 days, and 81.0% (95% CI, 77.5-84.7%) at 1 year.
Bone-targeting agent therapy is initiated by the majority of men living with bone metastases following a prostate cancer diagnosis; however, the timing of initiation is highly variable. Once on treatment, gaps or interruptions in therapy are common.
研究两种骨靶向药物（BTAs）——地诺单抗和唑来膦酸——对前列腺癌骨转移男性患者的治疗动态。
利用来自美国各地肿瘤治疗机构的电子健康记录数据，我们确定了2012/2013年被诊断为骨转移且在诊断前6个月内无使用BTA证据的前列腺癌患者。我们研究了开始使用BTA、中断使用以及重新开始使用的风险和预测因素。
在897名被诊断为前列腺癌的男性中，骨转移诊断后30天开始使用BTA的累积发生率为34%（95%置信区间[CI]，31 - 37%），180天为64%（95% CI，61 - 68%），2年时为88%（95% CI，85 - 91%）。地诺单抗的起始使用频率高于唑来膦酸。患有糖尿病、骨病变较多、有雄激素剥夺治疗史或未登记临终关怀的男性更有可能开始治疗。开始治疗后，60天治疗中断的累积发生率为17%（95% CI，14 - 19%），2年时为70%（95% CI，66 - 74%），接受前列腺癌新疗法或登记临终关怀的患者中断治疗的可能性更大。中断治疗后重新开始使用的累积发生率在15天时为36.3%（95% CI，32.7 - 40.2%），30天时为49.8%（95% CI，45.9 - 54.1%），1年时为81.0%（95% CI，77.5 - 84.7%）。
大多数前列腺癌骨转移男性患者在诊断后开始使用骨靶向药物治疗；然而，开始治疗的时间差异很大。一旦开始治疗，治疗间隙或中断很常见。
