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Poster session 14

1790P - Utilisation rates of treatment intensification for metastatic hormone sensitive prostate cancer (mHSPC) in England, UK

Date

21 Oct 2023

Session

Poster session 14

Topics

Cancer Registries;  Cancer Intelligence (eHealth, Telehealth Technology, BIG Data);  Cancer Care Equity Principles and Health Economics;  Therapy

Tumour Site

Prostate Cancer

Presenters

Joanna Dodkins

Citation

Annals of Oncology (2023) 34 (suppl_2): S954-S1000. 10.1016/S0923-7534(23)01946-4

Authors

J. Dodkins1, A. Cook1, J. Nossiter1, H.A. Payne2, N.W. Clarke3, J. van der Meulen4, A. Aggarwal4

Author affiliations

  • 1 Clinical Effectiveness Unit, Royal College of Surgeons of England, WC2A 3PE - London/GB
  • 2 Department Of Oncology, University College London Hospitals NHS Foundation Trust, NW1 2BU - London/GB
  • 3 Department Of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester/GB
  • 4 Department Of Health Services Research And Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT - London/GB

Resources

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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.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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