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Treatment for Metastatic Castration-Resistant Prostate Cancer: Real-World vs CARD Study
Study findings suggest that the CARD study population is reflective of real-world clinical practice and that sequential use of androgen-receptor-targeted agents (ARTAs) before chemotherapy initiation is common (Prostate Cancer Prostatic Dis. 2022. doi:10.1038/s41391-021-00487-1).
“The CARD study demonstrated superiority of cabazitaxel over abiraterone/enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) who received prior docetaxel and progressed ≤12 months on the alternative androgen-receptor-targeted agent (ARTA).
This study aimed to compare characteristics and treatment patterns of patients in a real-world dataset to those in the CARD population.
Data on patient and disease characteristics, history of prostate cancer, baseline laboratory outcomes, and details or previous therapy and treatment exposure were collected from the Medimix Live Tracker database. Patients with metastatic CRPC who received ≥1 of active treatment between 2001 and 2019 were included in the study. In addition, a CARD-like cohort was created, comprising patients with metastatic CRPC who had received treatment with docetaxel prior to abiraterone/enzalutamide and cabazitaxel.
A total of 12,140 were included in the study; 35% (n = 3142) received ≥2 lines of ARTA and 42% (n = 5118) who received a first-line ARTA received another ARTA in second line. Of the total patients, 452 were eligible for the CARD-like cohort.
The median age of patients in the CARD-like cohort was 73 years, which was comparable to the CARD study (70 years). Patients in the CARD-like cohort had unfavorable disease characteristics compared to those in the CARD study: ECOG performance status ≥2 (45% vs 4.7%, respectively), metastasis at diagnosis (46% vs 38%), and Gleason score 8-10 (65% vs 57%).
In the CARD-like cohort, 48% of patients received ARTA before docetaxel compared to 39% of patients in the CARD study. In addition, 30% of patients in the CARD-like cohort received the first ARTA for >12 months compared to 17% in the CARD study.
Treatment duration with cabazitaxel was similar between the CARD-like cohort and the CARD study (21.9 weeks vs 22 weeks, respectively), although more patients in the CARD-like cohort received the lower dose of cabazitaxel (55% vs 21%).
“This real-world evidence study… demonstrated that sequential use of ARTAs before chemotherapy initiation is common practice,” concluded Dr de Wit and colleagues.
“Results indicate the CARD population is reflective of routine clinical practice and duration of response to cabazitaxel was similar in a real-world population,” they added.
