San Francisco, CA USA (UroToday.com) In an analysis of a very large database to elucidate the prevalence of glucocorticoid use among both treated and untreated prostate cancer patients, 70% of patients who received chemotherapy and 88% of patients receiving oral therapies (abiraterone and enzalutamide) for metastatic disease also received glucocorticoids (GC). Approximately 30% of untreated patients and 40% of treated patients were prescribed glucocorticoids during a period of observation, according to a large review of over 300,000 cases recently reported at the 2016 ASCO Genitourinary Cancers Symposium.1
Investigators found a particularly high use of glucocorticoid treatments for age-related conditions such as chronic obstructive pulmonary and inflammatory conditions. The study’s author, Lorie Ellis, PhD, Associate Director Health Economics and Outcomes Research at Janssen Scientific Affairs, pointed to a need for awareness among clinicians of a“...significant prevalence of glucocorticoid use in ‘the real world’ that may be important to help physicians choose optimal treatment strategies that are compatible with other medications...” that are taken at the same time. 1,2
From the Truven Health MarketScan databases, the authors identified patients with two or more prostate cancer diagnoses or one or more claim(s) for a prostate cancer therapy, and 12 or more months of continuous eligibility between January 2015 and July 2014. They defined the index date for the treated cohort (i.e., patients receiving LHRH agonist, adrenal blocker, anti-androgen, chemotherapy, oral mCRPC therapy, surgery, or radiation) as the date of the most recent prostate cancer treatment. The index date for the untreated cohort (i.e., patients with a prostate cancer diagnosis but no prostate cancer treatment) was defined as the most recent date of a prostate cancer diagnosis.
Glucocorticoid use was determined post-index date for both treated and untreated prostate cancer patients using descriptive statistics. Baseline demographics and comorbidities were also reported.
Of a total of 321,113 eligible prostate cancer cases the investigators identified for analysis, 223,953 were untreated and 97,160 received prostate cancer therapy.
Untreated patients had a mean age of 68 years and a mean Quan-Charlson comorbidity index (CCI) of 1.7. Treated patients had a mean age of 71 years and a mean CCI of 1.8.
Untreated patients received a median daily glucocorticoid dose of 24 mg. Treated patients were given a median daily dose of glucocorticoid of 20 mg. Chemotherapy-treated patients received a median daily glucocorticoid dose of 14 mg, and patients who were treated with oral mCRPC therapies received a lower, 10 mg, median daily glucocorticoid dose. (The median daily dose of glucocorticoid dose tended to be lower in treated patients than in those who remained untreated for the disease.)
Clinicians should be made aware of circumstances where glucocorticoid use may be in use by patients for the treatment of conditions other than prostate cancer, and taken into account in treatment decision-making, say the authors.
“To our knowledge”, said Dr. Ellis, speaking to UroToday about the findings, “...studies of glucocorticoid treatment patterns in treated and untreated prostate cancer patients have not been widely reported. Awareness of the significant prevalence of glucocorticoid usage in the real world may be important to help
physicians choose optimal treatment strategies that are compatible with existing medications.”
She noted that she and her colleagues are currently preparing manuscripts for publication that will provide significantly more detailed analyses along with the results, and a discussion of the findings’ implications.
1. Ellis L, Behl A, Xiao Y, et al. Prevalence of glucocorticoid use in prostate cancer patients. J Clin Oncol. 2016;34: suppl 2S. Abstract 336.
2. Montgomery B, Cheng HH, Dreschsler J, Mostaghel EA. Glucocorticoids and prostate cancer treatment: friend or foe? Asian J Andriol. 2014;16;354-358.