Department of Hematology Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
Oncology, Adelphi Real World, Bollington, UK.
Oncologist. 2023 Sep 7;28(9):780-789. doi: 10.1093/oncolo/oyad045.
Continuous androgen deprivation therapy ± first-generation non-steroidal antiandrogen was previously the standard-of-care for patients with metastatic castration-sensitive prostate cancer (mCSPC). Treatment intensification with novel hormonal therapy (NHT) or taxane chemotherapy is now approved and guideline-recommended for these patients.
Physician-reported data on adult patients with mCSPC from the Adelphi Prostate Cancer Disease Specific Programme were analyzed descriptively. We evaluated real-world treatment trends for patients with mCSPC in 5 European countries (United Kingdom, France, Germany, Spain, and Italy) and the United States (US), looking at differences between patients initiating treatment in 2016-2018 and in 2019-2020. We also investigated treatment trends by ethnicity and insurance status in the US.
This study found that most patients with mCSPC do not receive treatment intensification. However, greater use of treatment intensification with NHT and taxane chemotherapy was observed in 2019-2020 than in 2016-2018 across 5 European countries. In the US, greater use of treatment intensification with NHT in 2019-2020 than in 2016-2018 was observed for all ethnicity groups and those with Medicare and commercial insurance status.
As the number of patients with mCSPC who receive treatment intensification increases, more patients who progress to metastatic castration-resistant prostate cancer (mCRPC) will have been exposed to intensified treatments. Treatment options for patients with mCSPC and mCRPC overlap, suggesting that an unmet need will emerge for new therapies. Further studies are needed to understand optimal treatment sequencing in mCSPC and mCRPC.
在转移性去势敏感型前列腺癌（mCSPC）患者中，连续雄激素剥夺治疗（ADT）+第一代非甾体类抗雄激素治疗曾是标准治疗方案。目前，新型激素治疗（NHT）或紫杉烷类化疗的治疗强化已获得批准并被纳入指南推荐，适用于此类患者。
对来自 Adelphi 前列腺癌疾病专项计划的 mCSPC 成年患者的医生报告数据进行了描述性分析。我们评估了 5 个欧洲国家（英国、法国、德国、西班牙和意大利）和美国 mCSPC 患者的真实世界治疗趋势，比较了 2016-2018 年和 2019-2020 年开始治疗的患者之间的差异。我们还在美国调查了不同种族和保险状况患者的治疗趋势。
本研究发现，大多数 mCSPC 患者并未接受治疗强化。然而，与 2016-2018 年相比，2019-2020 年欧洲 5 国 NHT 和紫杉烷类化疗的治疗强化应用更为广泛。在美国，所有种族和 Medicare 和商业保险的患者中，2019-2020 年 NHT 治疗强化的应用均多于 2016-2018 年。
随着接受治疗强化的 mCSPC 患者数量增加，更多进展为转移性去势抵抗性前列腺癌（mCRPC）的患者将接受强化治疗。mCSPC 和 mCRPC 的治疗方案存在重叠，这表明新疗法将出现未满足的需求。需要进一步研究以了解 mCSPC 和 mCRPC 中的最佳治疗顺序。
