Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada.
Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
Clin Genitourin Cancer. 2024 Oct;22(5):102115. doi: 10.1016/j.clgc.2024.102115. Epub 2024 May 9.
Data are needed to improve the current understanding of clinical management and characteristics of patients with advanced prostate cancer (PC) treated with androgen receptor pathway inhibition (ARPI) therapy.
This retrospective cohort study using real-world, population-level data from Alberta, Canada included all individuals diagnosed in 2017-2020 with de novo metastatic castration-sensitive PC (mCSPC) or nonmetastatic castration-resistant PC (nmCRPC) who initiated androgen deprivation therapy (ADT). For mCSPC, patients were classified as ARPI-exposed if they received an ARPI within 180 days of initiating ADT, while patients with nmCRPC were classified as ARPI-exposed if they received an ARPI within 2 years of diagnosis.
This study included 976 patients with mCSPC and 233 with nmCRPC of which 33.5% and 25.3% received an ARPI, respectively. The proportion of patients with mCSPC treated with an ARPI increased considerably for patients diagnosed in 2020 compared to 2017 (56.2% vs. 6.0%). In contrast, the use of ARPI to treat nmCRPC only increased marginally from 2017 to 2019/2020 (19.7% vs. 28.9%). Patients with mHSPC who were ARPI-exposed had longer median survival than patients who were ARPI-naive (38.47 (95% CI = 32.84-NA) vs. 34.19 (95% CI = 33.33-38.83; P = .03)), with a higher proportion of patients surviving to 2-years. For nmCRPC, survival was similar between ARPI-exposed and ARPI-naive. In multivariable analyses, receiving ARPI for mCSPC was associated with younger patient age, more recent diagnoses, fewer comorbidities, a higher number of metastatic sites, referral to a medical oncologist as well as receiving surgery and radiation before ADT. Receiving ARPI for nmCRPC was associated with referral to a medical oncologist, younger age, and more recent diagnoses.
Outcome analyses in this population suggest a continued unmet clinical need and complex clinical management pathways. Given that treatment pathways have evolved considerably, continued follow-up to understand the impact of these advancements on patient outcomes are warranted.
需要数据来提高对接受雄激素受体通路抑制 (ARPI) 治疗的晚期前列腺癌 (PC) 患者的临床管理和特征的现有认识。
本回顾性队列研究使用来自加拿大艾伯塔省的真实世界、人群水平数据，纳入 2017-2020 年期间初诊为去势敏感性转移性前列腺癌 (mCSPC) 或非转移性去势抵抗性前列腺癌 (nmCRPC) 且开始接受雄激素剥夺治疗 (ADT) 的所有患者。对于 mCSPC，如果患者在开始 ADT 的 180 天内接受 ARPI，则将其归类为 ARPI 暴露；如果 nmCRPC 患者在诊断后 2 年内接受 ARPI，则将其归类为 ARPI 暴露。
本研究纳入了 976 例 mCSPC 患者和 233 例 nmCRPC 患者，其中分别有 33.5%和 25.3%接受了 ARPI 治疗。与 2017 年相比，2020 年诊断为 mCSPC 的患者接受 ARPI 治疗的比例显著增加（56.2% vs. 6.0%）。相比之下，nmCRPC 患者接受 ARPI 治疗的比例仅从 2017 年到 2019/2020 年略有增加（19.7% vs. 28.9%）。接受 ARPI 治疗的 mHSPC 患者的中位总生存期长于未接受 ARPI 治疗的患者（38.47 (95%CI=32.84-NA) vs. 34.19 (95%CI=33.33-38.83；P=0.03），有更高比例的患者存活至 2 年。对于 nmCRPC，ARPI 暴露组与 ARPI 未暴露组的生存情况相似。多变量分析显示，接受 mCSPC 的 ARPI 治疗与患者年龄较小、诊断较新、合并症较少、转移灶数量较多、转诊至肿瘤内科医生以及在 ADT 前接受手术和放疗有关。nmCRPC 患者接受 ARPI 治疗与转诊至肿瘤内科医生、年龄较小和诊断较新有关。
该人群的结局分析表明仍存在未满足的临床需求和复杂的临床管理途径。鉴于治疗途径已经发生了很大的变化，需要持续随访以了解这些进展对患者结局的影响。
