Bilen Mehmet A, Khilfeh Ibrahim, Rossi Carmine, Morrison Laura, Diaz Lilian, Hilts Annalise, Lefebvre Patrick, Pilon Dominic, George Daniel J
Emory University School of Medicine, Atlanta, GA, United States.
Janssen Scientific Affairs, LLC, Horsham, PA, United States.
Oncologist. 2025 Jan 17;30(1). doi: 10.1093/oncolo/oyae183.
Patients with BRCA-positive metastatic castration-resistant prostate cancer (mCRPC) have an aggressive disease course. This study aimed to describe real-world treatment patterns among patients with BRCA-positive mCRPC.
De-identified electronic health record data from the Flatiron Health-Foundation Medicine Inc. Metastatic Prostate Cancer Clinico-Genomic Database (January 01, 2011 to June 30, 2022) were used to select patients with BRCA-positive mCRPC initiating first-line (1L) therapy with an oncologist-defined advanced line of therapy (LOT) or androgen deprivation therapy (ADT) monotherapy. Treatment sequences and reasons for censoring were described in 1L, and among patients who initiated a second-line (2L) therapy.
A total of 98 treated patients with BRCA-positive mCRPC were identified. The top 3 treatment regimens in 1L, overall, were ADT monotherapy (19%), enzalutamide (14%), and olaparib (13%). The main reason for censoring patients with ADT monotherapy was death (52.6%). Among 79 patients treated with an advanced LOT in 1L, 43.0% (n = 34) did not initiate a 2L therapy, of which, 29.4% died. In patients who initiated a 2L (n = 45), the most common 1L to 2L treatment sequence was olaparib to docetaxel (11.1%). The most prescribed 2L therapies were docetaxel (22.2%), olaparib (20.0%), abiraterone acetate (13.3%), and enzalutamide (11.1%). From 1L initiation, the median time-to-next-treatment was 6.2 months.
Among patients with BRCA-positive mCRPC, ADT monotherapy, enzalutamide, and olaparib were most commonly used. Prognosis of BRCA-positive patients was poor, with most patients failing initial therapy resulting in a switch to a new therapy or death. These findings highlight the need for earlier and more effective treatments for patients with BRCA-positive mCRPC.
携带BRCA基因且为转移性去势抵抗性前列腺癌（mCRPC）的患者病程进展迅速。本研究旨在描述携带BRCA基因且为mCRPC患者的真实世界治疗模式。
使用来自Flatiron Health- Foundation Medicine公司转移性前列腺癌临床基因组数据库（2011年1月1日至2022年6月30日）的去识别电子健康记录数据，筛选出开始一线（1L）治疗的携带BRCA基因且为mCRPC的患者，其接受肿瘤学家定义的晚期治疗线（LOT）或雄激素剥夺疗法（ADT）单药治疗。在1L治疗中以及开始二线（2L）治疗的患者中，描述了治疗顺序和审查原因。
共识别出98例接受治疗的携带BRCA基因且为mCRPC的患者。总体而言，1L治疗中最常用的3种治疗方案为ADT单药治疗（19%）、恩杂鲁胺（14%）和奥拉帕利（13%）。ADT单药治疗患者审查的主要原因是死亡（52.6%）。在1L治疗中接受晚期LOT治疗的79例患者中，43.0%（n = 34）未开始2L治疗，其中29.4%死亡。在开始2L治疗的患者（n = 45）中，最常见的1L至2L治疗顺序是从奥拉帕利转换为多西他赛（11.1%）。最常用的2L治疗药物是多西他赛（22.2%）、奥拉帕利（20.0%）、醋酸阿比特龙（13.3%）和恩杂鲁胺（11.1%）。从开始1L治疗起，下次治疗的中位时间为6.2个月。
在携带BRCA基因且为mCRPC的患者中，最常用的是ADT单药治疗、恩杂鲁胺和奥拉帕利。携带BRCA基因的患者预后较差，大多数患者初始治疗失败，导致更换新疗法或死亡。这些发现凸显了对携带BRCA基因且为mCRPC的患者进行更早且更有效治疗的必要性。
