Abstract 616P
Background
Randomized trials have shown that adding docetaxel (DOC) or novel hormonal therapy (NHT) to androgen deprivation therapy (ADT) improves survival in mCSPC. This retrospective study using the Medicare database (Jan 2009–Dec 2018) evaluated real-world utilization of advanced therapies for men with mCSPC over time by metastatic site and age.
Methods
The analysis included adult men with ≥1 PC claim who initiated ADT (index date) ≤90 days prior to or any time after a metastasis diagnosis. First-line (1L) treatment was grouped in 4 categories: ADT only, ADT + nonsteroidal antiandrogen (NSAA; ≥90-day use), ADT + DOC, and ADT + NHT. The 1L treatment distributions were described over time by metastatic site and by patient age (<75 years vs ≥75 years) at index date.
Results
Of 35,195 men with mCSPC (mean age 76.5 years), 26,892 (76.4%) received ADT-only as 1L treatment, 5,016 (14.3%) ADT + NSAA, 1,692 (4.8%) ADT + DOC, and 1,595 (4.5%) ADT + NHT. After the emergence of DOC and NHT for mCSPC in 2014 and 2017, respectively, treatment intensification with ADT + DOC and ADT + NHT was numerically higher for patients with bone and/or visceral vs node-only metastases (Table). However, the majority received ADT-only or ADT + NSAA, including those with visceral metastases. Utilization of ADT + DOC was lower in patients ≥75 years old while use of ADT + NHT was similar across age groups. Survival analysis across treatment cohorts is ongoing.
Conclusions
In this large, nationally representative sample, mCSPC treatment intensification occurred more frequently among patients with bone and/or visceral metastases than those with node-only metastasis. Adoption of ADT + DOC was lower among older patients, though uptake of ADT + NHT was similar regardless of age. However, the majority of patients with visceral metastases, even in the more recent time, still received ADT-only or ADT + NSAA, despite DOC and NHT availability in 2017-2018. Table: 616P
| Total N | ADT alone, % | ADT + NSAA, % | ADT + DOC, % | ADT + NHT, % | |
| Index year 2010-2013 | |||||
| Metastatic site | |||||
| Viscerala | 1,168 | 81.4 | 15.0 | 2.8-3.0 | <0.9 |
| Boneb | 7,013 | 79.5 | 18.4 | 1.3 | 0.9 |
| Node only | 1,115 | 84.5 | 13.8 | 1.0-1.2 | <1.0 |
| Age, years | |||||
| <75 | 5,159 | 83.1 | 14.5 | 1.8 | 0.5 |
| ≥75 | 6,112 | 81.7 | 16.6 | 0.8 | 0.9 |
| Index year 2014-2016 | |||||
| Metastatic site | |||||
| Viscerala | 1,447 | 73.1 | 12.4 | 11.7 | 2.7 |
| Boneb | 8,323 | 71.6 | 17.2 | 8.8 | 2.4 |
| Node only | 1,714 | 82.9 | 12.7 | 3.4 | 0.9 |
| Age, years | |||||
| <75 | 6,141 | 74.2 | 13.1 | 11.3 | 1.4 |
| ≥75 | 7,436 | 77.3 | 16.4 | 3.9 | 2.4 |
| Index year 2017-2018 | |||||
| Metastatic site | |||||
| Viscerala | 1,085 | 68.0 | 9.3 | 9.7 | 13.0 |
| Boneb | 5,900 | 63.1 | 14.1 | 7.2 | 15.6 |
| Node only | 1,856 | 81.3 | 9.3 | 1.8 | 7.7 |
| Age, years | |||||
| <75 | 4,881 | 69.2 | 9.8 | 8.7 | 12.3 |
| ≥75 | 5,472 | 71.7 | 13.8 | 2.6 | 11.8 |
aAlone or with other sites; bAlone or with node
Clinical trial identification
Editorial acknowledgement
Medical writing assistance funded by both sponsor companies was provided by Kirstie Anderson and Matthieu Larochelle, MD, of Onyx (a Prime Global agency).
Legal entity responsible for the study
Pfizer, Inc. and Astellas Pharma, Inc.
Funding
Pfizer, Inc. and Astellas Pharma, Inc.
Disclosure
D.J. George: Financial Interests, Personal, Other, Senior Editor: American Association for Cancer Research; Financial Interests, Personal and Institutional, Other, Consultant: Astellas; Financial Interests, Personal and Institutional, Other, Research: Astellas; Financial Interests, Personal and Institutional, Advisory Board: Astellas; Financial Interests, Personal and Institutional, Other, Research: AstraZeneca; Financial Interests, Personal and Institutional, Other, Consultant: AstraZeneca; Financial Interests, Personal and Institutional, Advisory Board: AstraZeneca; Financial Interests, Personal and Institutional, Other, CAPI-281 Steering Committee member: AstraZeneca; Financial Interests, Personal, Other, Independent Contractor: Axess Oncology; Financial Interests, Personal, Other, Consultant: Bayer H/C Pharmaceuticals; Financial Interests, Personal, Invited Speaker: Bayer H/C Pharmaceuticals; Financial Interests, Personal, Other, Honorarium: Bayer H/C Pharmaceuticals; Financial Interests, Personal, Other, Travel accommodations: Bayer H/C Pharmaceuticals; Financial Interests, Personal, Other, SC: Bayer H/C Pharmaceuticals; Financial Interests, Personal and Institutional, Other, Consultant: BMS; Financial Interests, Personal and Institutional, Other, Honorarium: BMS; Financial Interests, Personal and Institutional, Other, Research: BMS; Financial Interests, Institutional, Other, Consultant: Calithera; Financial Interests, Personal, Advisory Board: Capio Biosciences; Financial Interests, Personal, Other, Consultant: Constellation Pharmaceuticals; Financial Interests, Personal, Other, Honorarium: EMD Serono; Financial Interests, Personal and Institutional, Other: Exelixis, Inc; Financial Interests, Personal and Institutional, Other, Consultant: Exelixis, Inc; Financial Interests, Personal and Institutional, Invited Speaker: Exelixis, Inc; Financial Interests, Personal and Institutional, Other, Honorarium: Exelixis, Inc; Financial Interests, Personal and Institutional, Other, Travel accommodations: Exelixis, Inc; Financial Interests, Personal, Other, Consultant: Flatiron; Financial Interests, Personal, Other, Honorarium: Ipsen; Financial Interests, Personal and Institutional, Other, Research: Janssen Pharmaceuticals; Financial Interests, Personal and Institutional, Other, Consultant: Janssen Pharmaceuticals; Financial Interests, Personal and Institutional, Other, IDMC: Janssen Pharmaceuticals; Financial Interests, Personal, Other, Consultant: MSD; Financial Interests, Personal, Other, Honorarium: Michael J Nehhessey Associates; Financial Interests, Personal, Other, Consultant: Michael J Nehhessey Associates; Financial Interests, Personal, Other, Co-Editor in Chief: Millennium Medical Publishing, Clinical Advances in Hematology and Oncology; Financial Interests, Personal, Advisory Board: Modra Pharmaceuticals BV; Financial Interests, Personal, Other, Consultant: Myovant Sciences, Inc; Financial Interests, Personal, Other, NCI Genitourinary Steering Committee member: Leidos Biomedical Research Inc; Financial Interests, Personal, Other, Steering committee: Nektar Therapeutics; Other, Institutional, Other, Research: Novartis; Financial Interests, Personal, Other, Consultant: Physician Education Resource LLC; Financial Interests, Personal and Institutional, Other, Research: Pfizer; Financial Interests, Personal and Institutional, Other, Consultant: Pfizer; Financial Interests, Personal and Institutional, Other, Steering committee: Pfizer; Financial Interests, Personal and Institutional, Other, Honorarium: Pfizer; Financial Interests, Personal, Other, Consultant: Propella TX (formerly Vizuri); Financial Interests, Personal, Other, Consultant: RevHealth, LLC; Financial Interests, Personal and Institutional, Other, Research: Sanofi; Financial Interests, Personal and Institutional, Other, Consultant: Sanofi; Financial Interests, Personal and Institutional, Invited Speaker: Sanofi; Financial Interests, Personal and Institutional, Other, Honorarium: Sanofi; Financial Interests, Personal and Institutional, Other, Travel accommodations: Sanofi; Financial Interests, Personal, Other, Honorarium: UroGPO; Financial Interests, Personal, Other, Honorarium: UroToday; Financial Interests, Personal, Other, Travel accommodations: UroToday. N. Agarwal: Financial Interests, Personal, Other, Consultant: Astellas; Financial Interests, Personal, Other, Consultant: AstraZeneca; Financial Interests, Personal, Other, Consultant: Aveo; Financial Interests, Personal, Other, Consultant: Bayer; Financial Interests, Personal, Other, Consultant: BMS; Financial Interests, Personal, Other, Consultant: Calithera; Financial Interests, Personal, Other, Consultant: Clovis; Financial Interests, Personal, Other, Consultant: Eisai; Financial Interests, Personal, Other, Consultant: Eli Lilly; Financial Interests, Personal, Other, Consultant: EMD Serono; Financial Interests, Personal, Other, Consultant: Exelixis; Financial Interests, Personal, Other, Consultant: Foundation Medicine; Financial Interests, Personal, Other, Consultant: Genentech; Financial Interests, Personal, Other, Consultant: Gilead; Financial Interests, Personal, Other, Consultant: Janssen; Financial Interests, Personal, Other, Consultant: Merck; Financial Interests, Personal, Other, Consultant: MEI Pharma; Financial Interests, Personal, Other, Consultant: Nektar; Financial Interests, Personal, Other, Consultant: Novartis; Financial Interests, Personal, Other, Consultant: Pfizer; Financial Interests, Personal, Other, Consultant: Pharmacyclics; Financial Interests, Personal, Other, Consultant: Seattle Genetics. K. Ramaswamy: Financial Interests, Personal, Other, Employee: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer. R. Sandin: Financial Interests, Personal, Stocks/Shares: Pfizer; Financial Interests, Personal, Other, Employee: Pfizer. D. Russell: Financial Interests, Personal, Other, Employee: Pfizer; Financial Interests, Personal, Stocks/Shares: Pfizer. A. Hong: Financial Interests, Personal, Other, Employee: Astellas. H. Yang: Financial Interests, Personal, Other, Employee: Analysis Group, Inc; Financial Interests, Institutional, Other, Analysis Group has received funding for this study: Pfizer. W. Gao: Financial Interests, Personal, Other, Employee: Analysis Group, Inc; Other, Institutional, Other, Analysis Group has received funding for this study: Pfizer. K. Hagan: Financial Interests, Personal, Other, Employee: Vertex. S.J. Freedland: Financial Interests, Personal and Institutional, Other, Consultant: Pfizer; Financial Interests, Personal and Institutional, Other, Consultant: Astellas; Financial Interests, Personal and Institutional, Other, Consultant: Janssen; Financial Interests, Personal and Institutional, Other, Consultant: Bayer; Financial Interests, Personal and Institutional, Other, Consultant: Sanofi; Financial Interests, Personal and Institutional, Other, Consultant: Clovis; Financial Interests, Personal and Institutional, Other, Consultant: Merck; Financial Interests, Personal and Institutional, Other, Consultant: AstraZeneca; Financial Interests, Personal and Institutional, Other, Consultant: Myovant; Financial Interests, Personal and Institutional, Other, Consultant: Exact Sciences; Financial Interests, Personal and Institutional, Invited Speaker: Sanofi; Financial Interests, Personal and Institutional, Invited Speaker: AstraZeneca.