Learning From Evidence: Changes in Real-World Use of Second Androgen Receptor Targeted Treatments in Metastatic Castration-Resistant Prostate Cancer (mCRPC)
Dianne Bosch , Kim J.M. van der Velden , Tom Belleman , Welmoed K. van Deen , André M. Bergman , Maarten J. van der Doelen , Alfons J.M. van den Eertwegh , Winald R. Gerritsen , Reindert J.A. van Moorselaar , Diederik M. Somford , Metin Tascilar , Hans M. Westgeest , Carin A. Uyl-de Groot , Peter F.A. Mulders , Malou C.P. Kuppen , Inge M. van Oort
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Abstract
Background
Androgen receptor targeted therapies (ART) play a major role in the treatment of metastatic castration-resistant prostate cancer (mCRPC). In recent years consensus has been reached that treatment with a second ART should be avoided due to low response rates. The aim of this study was to investigate if new scientific insights led to changes in clinical daily practice in the Netherlands.
Methods
Patients included in the Dutch CAPRI-3 prostate cancer registry, currently encompassing 19 hospitals, and treated with at least 1 ART (ie, abiraterone or enzalutamide) were included. Patients were stratified based on start date of first ART (ART1) according to standard of care between 2016-2017, 2018-2019 and 2020-2021. Second ART (ART2) was defined as either direct (ART1>ART2) or at any given time (any ART2).
Results
Between the first and last ART1 group, the prevalence of ART1>ART2 declined from 14.3% to 6.5% (P = .001) and the prevalence of any ART2 from 27.6% to 10.7% (P < .001). The decline was observed before recommendations were included in European guidelines. The use of other life-prolonging drugs (LPDs) after ART1 (ART1>LPD) increased. Patients who were selected for ART1>ART2 instead of ART1>LPD were older, less frequently treated with taxane-based chemotherapy for mHSPC and had a longer time to development of mCRPC.
Conclusions
New scientific insights were incorporated into clinical daily practice, with a significant decline in in the prevalence of sequential ART treatment, even before recommendations were included in European guidelines.
期刊介绍：
Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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