Kimura Takahiro, Ito Takuma, Taguchi Tomoyuki, Hattori Kana, Matsuyama Rei
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Market Access & Public Affairs, Bayer Yakuhin, Ltd., Osaka, Japan.
Jpn J Clin Oncol. 2025 Apr 6;55(4):399-405. doi: 10.1093/jjco/hyae177.
The introduction of novel drugs for metastatic castration-sensitive prostate cancer has expanded treatment options for patients. Associated changes in healthcare resource utilization may have occurred in tandem, but nationwide information is limited. This study aimed to describe initial treatment patterns and healthcare resource utilization (including costs) for patients with metastatic castration-sensitive prostate cancer in routine clinical practice in Japan.
This retrospective, longitudinal cohort study used a large-scale claims database covering acute care hospitals of various sizes. Included were men who received first medical treatment for metastatic castration-sensitive prostate cancer between January 2015 and July 2021 (identification period). The primary endpoint was the initial treatment pattern for metastatic castration-sensitive prostate cancer.
Among 7665 men with metastatic castration-sensitive prostate cancer, the median (Q1, Q3) duration of first-line therapy was 8.2 (3.4, 17.3) months. During the overall period between 2015 and 2021, the most common initial pharmacotherapy (88.1% of treatment regimens) was 'combined androgen blockade or androgen deprivation therapy only or first-generation anti-androgen only'. Use of androgen receptor signaling inhibitors increased following their introduction in 2018, reaching 26.6% of treatments started in 2021 (abiraterone + androgen deprivation therapy 9.4%, apalutamide + androgen deprivation therapy 9.2%, enzalutamide + androgen deprivation therapy 8.0%). Median total healthcare-related cost per person-year was JPY 244 479, with metastatic castration-sensitive prostate cancer drugs accounting for approximately one-third of the cost (JPY 396 620).
Since androgen receptor signaling inhibitors were introduced, treatment patterns in patients with metastatic castration-sensitive prostate cancer in Japan have shifted, with an increased trend toward prescription of these agents. However, the most frequently used regimen for first-line treatment continues to be 'combined androgen blockade or androgen deprivation therapy only or first-generation anti-androgen only'.
新型药物用于转移性去势敏感性前列腺癌的引入，为患者扩大了治疗选择。医疗资源利用方面的相关变化可能也随之发生，但全国性的信息有限。本研究旨在描述日本常规临床实践中转移性去势敏感性前列腺癌患者的初始治疗模式和医疗资源利用情况（包括费用）。
这项回顾性纵向队列研究使用了一个覆盖各种规模急症医院的大型索赔数据库。纳入的是在2015年1月至2021年7月期间（识别期）接受转移性去势敏感性前列腺癌首次治疗的男性。主要终点是转移性去势敏感性前列腺癌的初始治疗模式。
在7665例转移性去势敏感性前列腺癌男性患者中，一线治疗的中位（四分位间距）持续时间为8.2（3.4，17.3）个月。在2015年至2021年的整个期间，最常见的初始药物治疗（占治疗方案的88.1%）是“单纯联合雄激素阻断或雄激素剥夺治疗或仅第一代抗雄激素药物”。雄激素受体信号抑制剂在2018年引入后使用增加，在2021年开始的治疗中占比达到26.6%（阿比特龙+雄激素剥夺治疗占9.4%，阿帕他胺+雄激素剥夺治疗占9.2%，恩杂鲁胺+雄激素剥夺治疗占8.0%）。每人每年的医疗相关总费用中位数为244479日元，转移性去势敏感性前列腺癌药物约占费用的三分之一（396620日元）。
自引入雄激素受体信号抑制剂以来，日本转移性去势敏感性前列腺癌患者的治疗模式发生了转变，这些药物的处方有增加趋势。然而，一线治疗最常用的方案仍然是“单纯联合雄激素阻断或雄激素剥夺治疗或仅第一代抗雄激素药物”。
