Leaning Darren, Kaur Gagandeep, Morgans Alicia K, Ghouse Ray, Mirante Osvaldo, Chowdhury Simon
Department of Radiology and Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom.
Parexel Access Consulting, Parexel International, Mohali, Punjab, India.
Front Oncol. 2023 Sep 27;13:1240864. doi: 10.3389/fonc.2023.1240864. eCollection 2023.
Metastatic castration-resistant prostate cancer (mCRPC) is a lethal disease that imposes a major burden on patients and healthcare systems. Three structured literature reviews (treatment guidelines, treatment landscape, and human/clinical/patient burden) and one systematic literature review (economic burden) were conducted to better understand the disease burden and unmet needs for patients with late-stage mCRPC, for whom optimal treatment options are unclear.
Embase, MEDLINE, MEDLINE In-Process, the CENTRAL database (structured and systematic reviews), and the Centre for Reviews and Dissemination database (systematic review only) were searched for English-language records from 2009 to 2021 to identify mCRPC treatment guidelines and studies related to the treatment landscape and the humanistic/economic burden of mCRPC in adult men (aged ≥18 years) of any ethnicity.
In total, six records were included for the treatment patterns review, 14 records for humanistic burden, nine records for economic burden, three records (two studies) for efficacy, and eight records for safety. Real-world treatment patterns were broadly aligned with treatment guidelines and provided no optimal treatment sequencing beyond second line other than palliative care. Current post-docetaxel treatments in mCRPC are associated with adverse events that cause relatively high rates of treatment discontinuation or disruption. The humanistic and economic burdens associated with mCRPC are high.
The findings highlight a lack of treatment options with novel mechanisms of action and more tolerable safety profiles that satisfy a risk-to-benefit ratio aligned with patient needs and preferences for patients with late-stage mCRPC. Treatment approaches that improve survival and health-related quality of life are needed, ideally while simultaneously reducing costs and healthcare resource utilization.
转移性去势抵抗性前列腺癌（mCRPC）是一种致命疾病，给患者和医疗系统带来了沉重负担。开展了三项结构化文献综述（治疗指南、治疗现状以及人文/临床/患者负担）和一项系统性文献综述（经济负担），以更好地了解晚期mCRPC患者的疾病负担和未满足的需求，对于这些患者而言，最佳治疗方案尚不清楚。
检索Embase、MEDLINE、MEDLINE在研数据库、CENTRAL数据库（结构化和系统性综述）以及综述与传播中心数据库（仅系统性综述），查找2009年至2021年的英文记录，以识别mCRPC治疗指南以及与mCRPC在任何种族成年男性（年龄≥18岁）中的治疗现状和人文/经济负担相关的研究。
总共纳入了六项用于治疗模式综述的记录、十四项用于人文负担的记录、九项用于经济负担的记录、三项用于疗效的记录（两项研究）以及八项用于安全性的记录。真实世界的治疗模式与治疗指南大致相符，除了姑息治疗外，二线以上没有提供最佳治疗顺序。mCRPC目前的多西他赛治疗后方案与不良事件相关，这些不良事件导致较高的治疗中断率。与mCRPC相关的人文和经济负担很高。
研究结果凸显了缺乏具有新作用机制且安全性更可耐受的治疗选择，这些选择应满足晚期mCRPC患者的风险效益比，符合患者需求和偏好。需要能够提高生存率和与健康相关生活质量的治疗方法，理想情况下同时降低成本和医疗资源利用。
