ESMO Congress 2023 | OncologyPRO

Abstract 1790P

Background

Following several practice changing clinical trials regarding management of mHSPC, international guidelines now recommend ‘treatment intensification’ of ADT in combination with either docetaxel and/or novel hormonal therapy (NHT). The national utilisation of these treatments in England, UK and the determinants of variation are yet to be explored.

Methods

This national population based study using data from the National Prostate Cancer Audit (NPCA) identified all patients newly diagnosed with mHSPC in the English National Health Service (NHS) between 2018 and 2021. Patients receiving docetaxel, enzalutamide, abiraterone or apalutamide within 6 months of diagnosis were identified in the Systemic Anti-Cancer Dataset (SACT). Treatment patterns were studied in the overall population and also by age, ethnicity, deprivation and co-morbidity.

Results

Of the 13,820 men diagnosed with mHSPC in England between 2018 and 2021, 5,346 (38.7%) received ‘treatment intensification’ with either docetaxel, enzalutamide, abiraterone or apalutamide. Of these, 3,386 (24.5%) received docetaxel, 1,736 (12.6%) enzalutamide, 167 (1.2%) Abiraterone and 57 (0.4%) apalutamide. Utilisation of docetaxel peaked in 2018 and utilisation of enzalutamide has steadily increased (0.2% 2018 to 28.3% 2020). Abiraterone and Apalutamide utilisation have also increased during the study period (Table). Patients who were younger or who lived in least deprived areas or who had fewer co-morbidities were more likely to receive treatment intensification. There was no evidence of variation in utilisation according to patient ethnicity.

Table: 1790P

Percentage utilisation of treatment intensification for mHSPC over time

	2018	2019	2020	2021
Any treatment intensification	38.1%	38.3%	42.0%	36.7%
Docetaxel	37.6%	37.3%	11.6%	11.2%
Enzalutamide	0.2%	0.7%	28.3%	21.8%
Abiraterone	0.3%	0.3%	2.1%	2.1%
Apalutamide	0%	0%	0%	1.6%

Conclusions

This study identifies the underutilisation of treatment intensification for mHSPC in England, particularly amongst certain patient groups. Further studies are needed to understand the reasons for underutilisation of intensified treatments in this setting.