Despite the wealth of evidence demonstrating the efficacy of treatment intensification beyond androgen-deprivation therapy (ADT) among patients with de novo metastatic castration-sensitive prostate cancer (mCSPC), little is known of its real-world use. This study examined the real-world uptake of ADT treatment intensification among older men in a large Canadian province.
We performed a retrospective population-based cohort study using province-wide linked administrative data in Ontario, Canada. Patients 66 years of age and older with de novo mCSPC were included and their treatment with conventional ADT-based regimens, ADT plus next-generation androgen receptor axis-targeted therapy, and ADT plus docetaxel were identified and stratified by time.
From 2014 to 2019, 3556 patients were identified with de novo mCSPC. Most patients (n = 2794 [78.6%]) were treated with a conventional ADT regimen, whereas 399 (11.2%) patients received ADT intensification with docetaxel and 52 (1.5%) patients received abiraterone acetate plus prednisone. In a time-stratified analysis of ADT intensification before and after the pivotal AA+P trial (LATITUDE), AA+P uptake increased from 0.5% to 3.0%, whereas docetaxel use dropped from 12.0% to 10.0%. The median survival of the study population was 18 months (interquartile range = 10-31).
The majority of patients with de novo mCSPC are treated with ADT alone in the Canadian real-world setting, despite randomized clinical trial evidence of benefit with the use of ADT-intensified regimens. As ADT treatment intensification is substantially underused, better understanding of the barriers to treatment and targeted education to address them are needed.
JNCI cancer spectrum. 2021 Oct 01*** epublish ***
Christopher J D Wallis, Shawn Malone, Ilias Cagiannos, Scott C Morgan, Robert J Hamilton, Naveen S Basappa, Cristiano Ferrario, Geoffrey T Gotto, Ricardo Fernandes, Tamim Niazi, Krista L Noonan, Fred Saad, Sebastien J Hotte, Huong Hew, Katherine F Y Chan, Laura Park Wyllie, Bobby Shayegan
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada., Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada., Department of Surgery, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada., Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., Department of Oncology, McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada., Department of Surgery, Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada., Division of Medical Oncology, London Regional Cancer Program, London, ON, Canada., Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada., BC Cancer Agency, University of British Columbia, Surrey, BC, Canada., Genitourinary Oncology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montréal, QC, Canada., Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada., Medical Affairs, Janssen Inc, Toronto, ON, Canada., Institute of Urology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.