Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration

Abstract Background Limited real‐world data exist on treatment patterns and outcomes in patients with metastatic castration‐sensitive prostate cancer (mCSPC). Methods A retrospective cohort study was conducted, using the Veterans Health Administration claims database (April 2013–March 2018). Among 3...

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Autores principales:	Stephen J. Freedland, Rickard Sandin, Janvi Sah, Birol Emir, Qiao Mu, Anna Ratiu, Agnes Hong, Lucile Serfass, Scott T. Tagawa
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	anti‐androgen LHRH agonist LHRH antagonist overall survival prostate cancer Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/8572d3bbe63c4a15a397dc787e63798d
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spelling	oai:doaj.org-article:8572d3bbe63c4a15a397dc787e63798d2021-12-01T04:49:16ZTreatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration2045-763410.1002/cam4.4372https://doaj.org/article/8572d3bbe63c4a15a397dc787e63798d2021-12-01T00:00:00Zhttps://doi.org/10.1002/cam4.4372https://doaj.org/toc/2045-7634Abstract Background Limited real‐world data exist on treatment patterns and outcomes in patients with metastatic castration‐sensitive prostate cancer (mCSPC). Methods A retrospective cohort study was conducted, using the Veterans Health Administration claims database (April 2013–March 2018). Among 369,734 prostate cancer patients, we selected all men who developed metastases within 90 days before or after medical/surgical castration and who received androgen deprivation therapy (ADT). Patients were categorized into four cohorts: ADT‐only (± <90‐day nonsteroidal anti‐androgen [NSAA] use), ADT + NSAA, ADT + docetaxel, and ADT + abiraterone. Main outcomes were treatment patterns, time‐to‐progression to metastatic castration‐resistant disease, and overall survival. Multivariable analysis and sensitivity analysis were conducted. Results Of 1395 patients, 874 (63%) received ADT‐only, 338 (24%) received ADT + NSAA, 108 (8%) received ADT + docetaxel, and 75 (5%) received ADT + abiraterone. Proportions on ADT‐only and ADT + NSAA declined (from 66% to 60% and from 31% to 17%, respectively) over the study period, while proportions prescribed ADT + docetaxel or abiraterone increased from 3% to 9% and from 1% to 15%, respectively. Patients treated with ADT + NSAA had similar risks of castration‐resistant disease (hazard ratio [HR] 1.05; 95% confidence interval [CI]: 0.87, 1.26) and overall mortality (HR 1.22; 95% CI: 0.97, 1.54) as ADT‐only. Conclusions Most patients with mCSPC initiating ADT received ADT‐only or ADT + NSAA, despite the emergence of docetaxel and novel hormonal therapies. Even in the most recent period (2017 to early 2018), only 24% of men received intensified therapy with agents known to prolong survival versus ADT‐only. These data in real‐world clinical practice suggest substantial room for improved outcomes in patients with mCSPC.Stephen J. FreedlandRickard SandinJanvi SahBirol EmirQiao MuAnna RatiuAgnes HongLucile SerfassScott T. TagawaWileyarticleanti‐androgenLHRH agonistLHRH antagonistoverall survivalprostate cancerNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 23, Pp 8570-8580 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anti‐androgen LHRH agonist LHRH antagonist overall survival prostate cancer Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	anti‐androgen LHRH agonist LHRH antagonist overall survival prostate cancer Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Stephen J. Freedland Rickard Sandin Janvi Sah Birol Emir Qiao Mu Anna Ratiu Agnes Hong Lucile Serfass Scott T. Tagawa Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
description	Abstract Background Limited real‐world data exist on treatment patterns and outcomes in patients with metastatic castration‐sensitive prostate cancer (mCSPC). Methods A retrospective cohort study was conducted, using the Veterans Health Administration claims database (April 2013–March 2018). Among 369,734 prostate cancer patients, we selected all men who developed metastases within 90 days before or after medical/surgical castration and who received androgen deprivation therapy (ADT). Patients were categorized into four cohorts: ADT‐only (± <90‐day nonsteroidal anti‐androgen [NSAA] use), ADT + NSAA, ADT + docetaxel, and ADT + abiraterone. Main outcomes were treatment patterns, time‐to‐progression to metastatic castration‐resistant disease, and overall survival. Multivariable analysis and sensitivity analysis were conducted. Results Of 1395 patients, 874 (63%) received ADT‐only, 338 (24%) received ADT + NSAA, 108 (8%) received ADT + docetaxel, and 75 (5%) received ADT + abiraterone. Proportions on ADT‐only and ADT + NSAA declined (from 66% to 60% and from 31% to 17%, respectively) over the study period, while proportions prescribed ADT + docetaxel or abiraterone increased from 3% to 9% and from 1% to 15%, respectively. Patients treated with ADT + NSAA had similar risks of castration‐resistant disease (hazard ratio [HR] 1.05; 95% confidence interval [CI]: 0.87, 1.26) and overall mortality (HR 1.22; 95% CI: 0.97, 1.54) as ADT‐only. Conclusions Most patients with mCSPC initiating ADT received ADT‐only or ADT + NSAA, despite the emergence of docetaxel and novel hormonal therapies. Even in the most recent period (2017 to early 2018), only 24% of men received intensified therapy with agents known to prolong survival versus ADT‐only. These data in real‐world clinical practice suggest substantial room for improved outcomes in patients with mCSPC.
format	article
author	Stephen J. Freedland Rickard Sandin Janvi Sah Birol Emir Qiao Mu Anna Ratiu Agnes Hong Lucile Serfass Scott T. Tagawa
author_facet	Stephen J. Freedland Rickard Sandin Janvi Sah Birol Emir Qiao Mu Anna Ratiu Agnes Hong Lucile Serfass Scott T. Tagawa
author_sort	Stephen J. Freedland
title	Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
title_short	Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
title_full	Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
title_fullStr	Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
title_full_unstemmed	Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration
title_sort	treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the us veterans health administration
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/8572d3bbe63c4a15a397dc787e63798d
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Treatment patterns and survival in metastatic castration‐sensitive prostate cancer in the US Veterans Health Administration

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