Less than one-third of patients with metastatic castration-sensitive prostate cancer (mCSPC) received treatment intensification, especially among Black patients, according to a large real-world study presented at the virtual 2021 ASCO Annual Meeting.

These findings were presented by Stephen J. Freedland, MD, Cedars-Sinai Medical Center, Los Angeles, CA, lead author of the study.

"For years, we’ve known that androgen deprivation therapy (ADT) is the standard treatment for mCSPC. However, in more recent years randomized trials have shown that adding either docetaxel or novel hormonal therapies, such as apalutamide, abiraterone, or enzalutamide, to ADT can significantly improve survival,” said Dr Freedland.

This study aimed to evaluate the real-world utilization of advanced therapies over time and provide data on utilization patterns among racial minorities, due to under-representation in clinical trials. The Medicare database was used to identify adult men with ≥1 claim for prostate cancer who initiated ADT (index date) within 90 days prior to or any time after a metastasic diagnosis.

First-line treatment was grouped by prostate cancer drugs prescribed within 30 days prior to and 120 after the index date: ADT alone, ADT plus first-generation anti-androgen, ADT plus docetaxel, and ADT plus nonhormonal therapies (abiraterone, apalutamide, and enzalutamide.

First-line treatment patterns were described over time and stratified by race.

A total of 35,195 patients (11.8% Black, 5.3% Hispanic, and 78.5% White) were included in the study. Overall, 76.4% received ADT alone as first-line treatment, 14.3% received ADT plus anti-andorgen, 4.8% ADT plus docetaxel, and 4.5% ADT plus nonhormonal therapy.

The proportion of patients treated with ADT alone and ADT plus anti-androgen therapy decreased over time. Since 2015, use of ADT plus docetaxel has increased, and since 2017, use of ADT plus nonhormonal therapy has increased.

After the introduction of nonhormonal therapies for mCSPC in 2017, treatment intensification with ADT plus nonhormonal therapy was lower for Black patients than White patients. Prior to 2017, data also suggested a similar lower use of ADT plus anti-androgen therapy in Black patients.

“In a large representative sample of US patients with mCSPC, less than one-third of patients received advanced therapies even by 2018. These could be due to various factors that still need to be sorted out,” concluded Dr Freedland.

“The major limitation of our data is that it ends in December 2018, not allowing us to assess the impact of more recent data from ENZAMET, ARCHES and TITAN. It will be interesting to see how these change treatment patterns overtime,” he added.—Marta Rybczynski

Freedland SJ, Agarwal N, Ramaswamy K, et al. Real-world utilization of advanced therapies and racial disparity among patients with metastatic castration-sensitive prostate cancer (mCSPC): A Medicare database analysis. Presented at: the 2021 ASCO Annual Meeting; June 4-8, 2021; virtual. Abstract 5073.