Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Merck & Co., Inc., Rahway, NJ.
Clin Genitourin Cancer. 2023 Oct;21(5):517-529. doi: 10.1016/j.clgc.2023.04.014. Epub 2023 May 3.
Prostate cancer (PC) is more likely to develop in men ≥65 years old than in those <65 years old. This study aimed to generate real-world evidence on treatment patterns, clinical outcomes, health care resource utilization (HCRU), and costs among older patients with metastatic castration-resistant PC (mCRPC).
A claims algorithm based on treatments expected for mCRPC was used to identify men ≥65 years old with mCRPC in the SEER-Medicare data between 2007 and 2019. The index date was defined as the date of the start of first-line therapy (1L). Treatment patterns and all-cause and PC-specific HCRU and costs were measured in the 12 months preindex period and the postindex follow-up period. Time to next treatment or death (TNTD) and overall survival (OS) were assessed in the follow-up period.
A total of 4758 patients met the eligibility criteria and received 1L treatment. Among these 1L patients, 57.4% subsequently received second-line (2L) treatment; among patients receiving 2L treatment, 49.3% subsequently received third-line (3L) treatment. Abiraterone, enzalutamide, and docetaxel were most common regimens in 1L (41.9%, 22.0%, 22.0%, respectively), 2L (33.3%, 32.7%, 13.6%, respectively), and 3L (17.9%, 25.1%, 22.3%, respectively). On average, patients had 1.2 inpatient admissions, 1.1 emergency room visits, and 27.6 outpatient visits per year during follow-up. The mean total all-cause and PC-related costs during the follow-up period were $111,060 and $99,540 per-patient-per-year, respectively. Median TNTD was 9.3, 6.5, and 5.7 months for 1L, 2L, and 3L, respectively. Median OS from the start of 1L treatment for mCRPC was 21.5 months.
Among older patients with mCRPC, high attrition from 1L to subsequent lines of therapy was observed. Median TNTD was <1 year and median OS was <2 years. These results highlight a need to introduce more effective mCRPC therapies in 1L to improve clinical outcomes for older patients.
前列腺癌（PC）在 65 岁及以上男性中比在 65 岁以下男性中更易发生。本研究旨在利用真实世界的数据生成转移性去势抵抗性前列腺癌（mCRPC）老年患者的治疗模式、临床结局、医疗资源利用（HCRU）和成本方面的证据。
使用一种基于 mCRPC 预期治疗方法的索赔算法，在 2007 年至 2019 年期间从 SEER-Medicare 数据中确定 65 岁及以上患有 mCRPC 的男性。索引日期定义为一线治疗（1L）开始的日期。在索引前 12 个月和索引后随访期间测量治疗模式以及全因和 PC 特异性 HCRU 和成本。在随访期间评估了下一次治疗或死亡（TNTD）和总生存期（OS）。
共有 4758 名患者符合入选标准并接受了 1L 治疗。在这些 1L 患者中，57.4%随后接受了二线（2L）治疗；在接受 2L 治疗的患者中，49.3%随后接受了三线（3L）治疗。阿比特龙、恩杂鲁胺和多西他赛是 1L（分别为 41.9%、22.0%、22.0%）、2L（分别为 33.3%、32.7%、13.6%）和 3L（分别为 17.9%、25.1%、22.3%）中最常见的方案。平均而言，患者在随访期间每年有 1.2 次住院治疗、1.1 次急诊就诊和 27.6 次门诊就诊。在随访期间，每位患者的全因和 PC 相关总费用分别为每年 111060 美元和 99540 美元。1L、2L 和 3L 的中位 TNTD 分别为 9.3、6.5 和 5.7 个月。从 mCRPC 一线治疗开始的中位 OS 为 21.5 个月。
在患有 mCRPC 的老年患者中，从一线治疗到后续治疗线的大量脱落现象很明显。中位 TNTD 小于 1 年，中位 OS 小于 2 年。这些结果强调需要在一线治疗中引入更有效的 mCRPC 疗法，以改善老年患者的临床结局。
