Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2022 Aug;52(8):1339-1346. doi: 10.1111/imj.15288. Epub 2022 May 31.
Docetaxel has emerged as a standard-of-care for metastatic hormone-sensitive prostate cancer (mHSPC). Uptake of docetaxel for mHSPC in Australia has not previously been reported.
To investigate the real-world uptake of docetaxel in mHSPC and to identify predictors of utilisation of docetaxel in mHSPC.
Men diagnosed from June 2014 to December 2018 and enrolled in the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic) were included. Data collected include demographics, diagnosis method and institution, staging investigations and treatments within 12 months of diagnosis. Wilcoxon rank-sum, Chi-squared and trend tests were used to identify predictors of docetaxel utilisation. All predictors were entered as covariates simultaneously into a multivariable logistic regression model. Statistical significance was set at 0.05 (two sided).
In all, 1014 men with mHSPC were analysed, 25% of whom received docetaxel with androgen deprivation therapy. Uptake of docetaxel increased from 20% in 2014 to 33% in 2018. Predictors of higher usage of docetaxel were younger age and treatment in a private hospital, with both remaining significant on multivariable analysis. Notably, the proportion of men aged <70 years receiving docetaxel increased from 54% in 2014-2015 to 64% in 2016-2018, while in men aged ≥70 years the comparative figures were 15% and 22% respectively.
Although docetaxel was not used in the majority of cases, there was a clear increase in docetaxel uptake, especially in younger men following publication of the CHAARTED and STAMPEDE trials. Identifying barriers to real-world implementation of pivotal clinical trial data is critical to improving outcomes in mHSPC.
多西他赛已成为转移性激素敏感型前列腺癌（mHSPC）的标准治疗方法。此前，尚未有关于澳大利亚 mHSPC 中多西他赛应用的报道。
研究 mHSPC 中多西他赛的实际应用情况，并确定 mHSPC 中应用多西他赛的预测因素。
纳入 2014 年 6 月至 2018 年 12 月期间在前列腺癌结局登记处-维多利亚州（PCOR-Vic）诊断并登记的男性患者。收集的数据包括人口统计学、诊断方法和机构、分期检查以及诊断后 12 个月内的治疗情况。Wilcoxon 秩和检验、卡方检验和趋势检验用于识别多西他赛应用的预测因素。所有预测因素均同时作为协变量纳入多变量逻辑回归模型。统计学显著性水平设为 0.05（双侧）。
共分析了 1014 例 mHSPC 患者，其中 25%的患者接受了多西他赛联合雄激素剥夺治疗。多西他赛的使用率从 2014 年的 20%增加到 2018 年的 33%。年龄较小和在私立医院接受治疗是多西他赛使用率较高的预测因素，这两个因素在多变量分析中仍然具有统计学意义。值得注意的是，年龄<70 岁的男性接受多西他赛治疗的比例从 2014-2015 年的 54%增加到 2016-2018 年的 64%，而年龄≥70 岁的男性则分别为 15%和 22%。
尽管大多数情况下并未使用多西他赛，但在 CHAARTED 和 STAMPEDE 试验发表后，多西他赛的使用率明显增加，尤其是在年轻男性中。确定实施关键性临床试验数据的实际障碍对于改善 mHSPC 的预后至关重要。
