Although numerous treatments with different mechanisms of action are approved for metastatic castration-resistant prostate cancer (mCRPC), the sequencing for management of these patients has been evolving post availability of trials, such as the CARD trial. In a study presented at the 2022 ASCO Annual Meeting, Shashank Ghantoji MD, PhD, Novartis Pharmaceuticals Corporation, East Hanover, NJ, and colleagues studied real-world treatment patterns and sequencing among patients with mCRPC in the United States. 

The research team used Flatiron Health electronic health record data between January 1, 2013 and June 30, 2020 for this retrospective cohort study. Patients were included if they met the following criteria: male aged ≥18 years, had a confirmed diagnosis of mCRPC within the study period, and received ≥1 systemic therapy post-mCRPC diagnosis. Index date was the date of first-line (1L) therapy initiation post-mCRPC diagnosis. Patient characteristics and treatment patterns were evaluated descriptively. Across analyses, treatments were grouped as follows: ARPI (abiraterone, enzalutamide), taxane (docetaxel, cabazitaxel), sipuleucel-T, radium-223, targeted therapy (TT; olaparib, rucaparib), mitoxantrone, combo therapy (any combination regimen containing ≥1 of the preceding therapies), and other (any other therapy or combination of therapies).

The study included2,588 patients; mean±SD age was 72±8 years and 66% were White. The most common 1L therapy was ARPI (63%), followed by taxane (11%), combo therapy (11%), radium-223 (6%), sipuleucel-T (6%), and other therapy (2%). No patient received TT or mitoxantrone alone in 1L. Median time to next treatment post-1L was longest for combo therapy (8.1 months) and ARPI (7.6 months) and shortest for sipuleucel-T (3.4 months). The most common sequence of treatment for mCRPC patients was 1L ARPI to another ARPI at second-line (2L) (29%); taxane and combo therapy (both 14%) were the next most common. Treatment patterns were similar pre- and post- read-out of the CARD trial.

“Blood cancer patients treated at NCI NCORP sites are experiencing financial difficulties,” wrote Dr Ghantoji and colleagues. “Results of this study aim to inform physician, site of care and policy efforts to improve access among cancer patients.”