Department of Research, Cancer Registry of Norway, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Acta Oncol. 2023 Dec;62(12):1716-1722. doi: 10.1080/0284186X.2023.2257876. Epub 2023 Nov 25.
Several new systemic treatments for primary metastatic prostate cancer patients (mPCa) were introduced in the last decade for both hormone-sensitive (mHSPC) and castration-resistant prostate cancer (mCRPC). However, little is known about the introduction of these treatments in clinical practice. In this national cohort study, we described users and non-users of systemic treatment beyond androgen deprivation therapy (ADT). We also explored whether there was a shift in treatment patterns after the introduction of Docetaxel for mHSPC patients.
All patients registered in the Cancer Registry of Norway with mPCa diagnosed in 2010-18 were included. Data on systemic therapy (Docetaxel, Abiraterone, Enzalutamide, Cabazitaxel, and Radium-223) were provided from the Norwegian Prescription Database, the Norwegian Patient Registry, and the Norwegian Control and Payment of Health Reimbursement Database. Descriptive results about patient and disease characteristics were presented using frequencies and proportions, means and standard deviations, or medians and interquartile ranges.
Of the 2770 patients included in this study, 48% received systemic treatment beyond ADT. The proportion of patients receiving systemic treatment increased during the study period. Systemic treatment users were younger, in better general condition, and had more aggressive tumors than non-users. A treatment shift was observed after 2015, with 48% of patients receiving systemic treatment (mainly Docetaxel) in the mHSPC phase compared to 4% of those diagnosed 2010-14. No significant treatment differences were observed across health regions.
An increasing proportion of patients received systemic treatment during the period 2010-18. However, less than 50% of patients in our study received systemic treatment. In accordance with updated guidelines, Docetaxel was introduced after 2015 with an increasing proportion of patients receiving systemic treatment as mHSPC. Further studies should address the disease course and treatment given to patients who do not receive systemic treatment.
过去十年中，针对原发性转移性前列腺癌（mPCa）患者，引入了几种新的全身治疗方法，包括激素敏感型（mHSPC）和去势抵抗型前列腺癌（mCRPC）。然而，在临床实践中，对于这些治疗方法的引入情况了解甚少。在本项全国性队列研究中，我们描述了接受和未接受去势治疗（ADT）以外的全身治疗的患者。我们还探讨了在 mHSPC 患者中引入多西他赛后，治疗模式是否发生了变化。
所有在 2010 年至 2018 年期间在挪威癌症登记处被诊断为 mPCa 的患者均被纳入本研究。全身治疗（多西他赛、阿比特龙、恩扎鲁胺、卡巴他赛和镭-223）的数据来自挪威处方数据库、挪威患者登记处和挪威控制和支付健康报销数据库。通过频率和比例、平均值和标准差或中位数和四分位间距，对患者和疾病特征的描述性结果进行了呈现。
在本研究中纳入的 2770 例患者中，有 48%的患者接受了 ADT 以外的全身治疗。在此研究期间，接受全身治疗的患者比例有所增加。与未使用者相比，全身治疗使用者年龄较小、一般状况较好，且肿瘤侵袭性更强。2015 年后，治疗模式发生了转变，在 mHSPC 阶段接受全身治疗（主要是多西他赛）的患者比例为 48%，而 2010-2014 年诊断的患者比例为 4%。不同卫生区域之间未观察到显著的治疗差异。
在 2010-2018 年期间，接受全身治疗的患者比例有所增加。然而，在我们的研究中，只有不到 50%的患者接受了全身治疗。按照最新指南，多西他赛于 2015 年后引入，接受全身治疗的患者比例逐渐增加，作为 mHSPC 的治疗方法。进一步的研究应该关注那些未接受全身治疗的患者的疾病进程和治疗情况。
