Learning From Evidence: Changes in Real-World Use of Second Androgen Receptor Targeted Treatments in Metastatic Castration-Resistant Prostate Cancer (mCRPC).

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.