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Poster display session

3048 - Practice Patterns in Metastatic Castration-Resistant Prostate Cancer (mCRPC): Evidence From the Veterans Health Administration

Date

10 Sep 2017

Session

Poster display session

Topics

Prostate Cancer

Presenters

Ahmad Halwani

Citation

Annals of Oncology (2017) 28 (suppl_5): v269-v294. 10.1093/annonc/mdx370

Authors

A. Halwani1, Z. Burningham2, K.M. Rasmussen2, V. Patil2, S. Narayanan3, S. Lin3, S. Carroll3, L. Hsu3, J. Graff4, R. Dreicer5, S. Gupta1, C. Low1, B.C. Sauer2

Author affiliations

  • 1 Division Of Hematology, Huntsman Cancer Institute, 84112 - Salt Lake City/US
  • 2 Division Of Epidemiology, University of Utah, 84112 - Salt Lake City/US
  • 3 Oncology, Genentech, Inc., 94080 - South San Francisco/US
  • 4 Division Of Oncology, Oregon Health & Science University- Knight Cancer Center, 97239 - Portland/US
  • 5 Division Of Hematology/oncology, University of Virginia, 22980 - Charlottesville/US
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Resources

Abstract 3048

Background

Practice patterns for metastatic castration-resistant prostate cancer (mCRPC) have evolved over the last decade due to introduction of agents such as abiraterone and enzalutamide. This study examines mCRPC treatment practices over a 10-year period (which includes the time periods before and after the introduction of novel oral anti-androgens) for the first 3 lines of therapy in the largest nationwide integrated health system in the United States, the Veterans Health Administration.

Methods

By linking patient information from the Veterans Affairs (VA) Clinical Cancer Registry to clinical notes, laboratory, procedure and imaging data from the VA Corporate Data Warehouse (CDW), we identified patients who were diagnosed with prostate cancer at the VA and ultimately developed mCRPC, defined as radiological evidence of metastasis and evidence of rising PSA levels concomitant with surgical (bilateral orchiectomy) or medical castrate testosterone levels (≤ 50 ng/dL within the last 3 months or ongoing treatment with androgen deprivation). Therapies used to treat mCRPC were extracted from CDW pharmacy dispensation records (docetaxel, abiraterone, enzalutamide, cabazitaxel, and others).

Results

From 2006 to 2015, 120,374 patients were diagnosed with prostate cancer, of whom 3,637 developed mCRPC. Median age at initial prostate diagnosis was 68 years (range, 41-94), average BMI was 26.5 (range, 9-59), average CCI score was 1.5 (range, 0-12) and average PSA was 45.5 ng/mL. Practices for the first 3 lines of treatment from 2006 to 2010 and 2011 to 2016 are summarized in Table 1. Patients diagnosed with mCRPC between 2006 and 2010 were more likely to receive cytotoxic therapy than patients diagnosed between 2011 and 2016 (37% vs 22%). Compared with the cohort diagnosed between 2006 and 2010, the later cohort was more likely to receive treatment (44% vs 62%) and was also more likely to receive > 1 line of therapy (20% vs 37%). For patients diagnosed between 2011 and 2016, the most common therapies were as follows: 1L, abiraterone (29%); 2L, abiraterone (15%) and enzalutamide (14%); and 3L, enzalutamide (8%).Table:

804P

ENTIRE COHORTa (2006-2016) N = 3,637mCRPC Diagnosis (2006-2010) N = 1,118mCRPC Diagnosis (2011-2016) N = 2,519
1L, % pts 2L, % pts 3L, % ptsDOC 27%, AA 22%, ENZ 6% AA 13%, ENZ 10%, DOC 4% ENZ 6%, DOC 4%, AA 3%DOC 37%, AA 4%, ENZ 1% AA 7%, MIT 5%, CAB 3% AA 3%, ENZ 2%, DOC 2%AA 29%, DOC 22%, ENZ 9% AA 15%, ENZ 14%, DOC 6% ENZ 8%, DOC 5%, AA 3%
No treatment, % pts1L 43%, 2L 68%, 3L 86%1L 56%, 2L 80%, 3L 90%1L 38%, 2L 63%, 3L 81%
Top 3 most common treatment sequences from 1L to 2L (% of pts)DOC-AA (11%) AA-ENZ (8%) AA-DOC (4%)DOC-AA (7%) DOC-MIT (5%) DOC-CAB (3%)DOC-AA (12%) AA-ENZ (11%) AA-DOC (5%)

AA, abiraterone acetate; CAB, cabazitaxel; DOC, docetaxel; ENZ, enzalutamide; MIT, mitoxantrone a

Conclusions

Our study is the first to describe adoption of non-chemotherapeutic treatments in a nationwide cohort of patients with mCRPC treated in the largest integrated healthcare system in the United States. Further research will focus on understanding clinical outcomes associated with this shift in practice patterns.

Clinical trial identification

N/A

Legal entity responsible for the study

Ahmad Halwani, MD

Funding

Genentech, Inc.

Disclosure

A. Halwani: Research funding: Kyowa Hikko Kirin, BMS, Seattle Genetics, Roche/Genentech, Genentech, Takeda, Pharmacyclics, Amgen, Abbvie, Immune Design, Miragen, Seattle Genetics. S. Narayanan: Stock ownership and employee of Roche/Genentech Inc. S-W. Lin: Stock ownership and employee of Roche/Genentech Inc. S. Carroll: Stock ownership and employee of by Genentech Inc. L-I. Hsu: Stock owner and employee of Genentech Inc. J. Graff: Honorarium from Astellas, research funding from Sanofi, Merck, Bristol Myers Squibb, Astellas, Janssen, travel funds from Sanofi, Merck, and Clovis. R. Dreicer: Consulting relationships with: Orion, Medivation, Astellas, Asana, Genentech, Roche, AstraZeneca, Exelexis, Eisai, Bristol Myers Squibb, Sanofi-Genzyme, EMD Serono. S. Gupta: Spouse: Stock ownership in Salarius Pharmaceuticals. B.C. Sauer: Research funding from Genentech Inc. and Amgen. All other authors have declared no conflicts of interest.

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