Impact of COVID-19 on Treatment of Patients With Metastatic Hormone Sensitive Prostate Cancer

Srikala Sridhar, MD, Princess Margaret Cancer Center, Toronto, Ontario, Canada, discusses a study done to evaluate how the COVID-19 pandemic has affected the treatment of patients with metastatic hormone-sensitive prostate cancer. 

Using a survey of 50 medical oncologists in Canada, the results showed an increase of androgen-receptor-axis targeted therapy along with decreased use of docetaxel. This trend is expected to persist beyond the pandemic.

Transcript:

Hi, my name is Dr. Srikala Sridha. I'm a medical oncologist at the Princess Margaret Cancer Center in Toronto, Ontario. Today I'm going to talk to you about a paper that we have just published. This paper's entitled "Evaluation of Trends in Treatment of Metastatic Hormone Sensitive Prostate Cancer (MHSPC) Across Canada During the Covid-19 Pandemic."

By way of background, we know that metastatic hormone sensitive prostate cancer is a highly aggressive disease. Recent studies have shown that treating this disease with a combination of androgen deprivation therapy or ADT, plus chemotherapy with docetaxel or androgen deprivation therapy with an ARAT, and that's an androgen receptor access targeted therapy, improves outcomes compared to doing ADT alone. This has been a really important shift in the field where we no longer recognize ADT alone as the standard of care.

For patients with metastatic hormone sensitive prostate cancer, we typically add either docetaxel or an ARAT to standard ADT. We were curious to understand how practice patterns evolved during the recent COVID-19 pandemic in Canada. We were curious to know if the use of ADT plus docetaxel went up or down and similarly, if the use of ADT plus ARAT was impacted by the pandemic. We used Survey SurveyMonkey to conduct an online survey of 119 medical oncologists across Canada from January 15th to January 27th of 2021. This was during the second wave of the COVID-19 pandemic. The survey consisted of 16 questions, including demographics, and asked specifically about the medical oncologist approach to managing metastatic hormone-sensitive prostate cancer both before and during the pandemic. When we looked at the results, there were 50 out of 119 respondents, and this is not uncommon for a survey-based studies, and there's many reasons for this.

In any case, most of the respondents were male. It's about 65%. They were from the province of Ontario, about 35%, and they were practicing in academic centers about 71%. It is important to note that many times when we do survey based studies, that we tend to capture the opinion of the academic clinicians, but less so those in the community, and that's something that we really need to work on going forwards. In any case, 45% of the respondents reported their practices focused primarily on genital urinary malignancies and one additional tumor site. The majority of respondents were also in practice one to five years, so they were relatively early in their practice. That was about 34% of the respondents. Importantly, 65% indicated that their practice patterns had changed since the pandemic. 51% were offering more ARATs in the context of metastatic hormone sensitive prostate cancer as opposed to docetaxel, and I think this is a bit of an important shift.

Initially, when the CHAARTED study came out, we were using ADT plus docetaxel. Following that when studies looking at an ADT plus ARAT came along, we saw a slight shift in practice accordingly. During the pandemic, we definitely in this study saw a shift in practice towards offering more ARATs and less docetaxel. In low volume metastatic hormone-sensitive prostate cancer, we saw the use of ARATs increasing from 73% to 79% while the use of docetaxel remained unaltered and low as would be expected at around 2%.

In high volume disease, we saw the use of ARATs increasing from 63% to 84% while the use of docetaxel decreased from 37% to 14%. Interestingly, we saw the use of GCSF [granulocyte colony stimulating factor] with docetaxel chemotherapy increasing by about 35%. So that was done in an effort to reduce neutropenia, reduce hospitalizations, especially in the context of COVID when many of our hospital beds were full. Post-pandemic, 45% reported that they intend to maintain the practice changes in terms of using more ARAT using less docetaxel. Only 18% reported that they had patients who developed COVID-19 mostly while they were receiving ADT plus ARAT and all patients recovered, and this could be indicative of the strong public health measures that we had here in Canada at the time.

Overall, to summarize, the management of patients with metastatic hormone-sensitive prostate cancer in Canada has changed during the pandemic with an increased use of ARATs and a decreased use of docetaxel. This trend we expect will continue well beyond the pandemic. How this trend will impact uptake of triple therapy, which is ADT plus, ARAT, plus docetaxel, which has recently been evaluated in a few studies, how it will impact downstream treatment choices and overall outcomes remains to be seen. But I think at the end of the day, what we can conclude that it is important for patients who have metastatic hormone sensitive prostate cancer to be receiving more than ADT. So that is either ADT, plus ARAT, ADT plus docetaxel, or potentially in appropriate patients, ADT, plus ARAT, plus docetaxel. The hope is that this would improve overall outcomes in this aggressive disease.

Source:

Stecca CE, Jiang DM, Veitch Z, et al. Evaluation of trends in treatment of metastatic hormone sensitive prostate cancer (mHSPC) across Canada during the COVID-19 pandemic. Clin Genitourin Cancer. Published online November 29, 2022. doi:10.1016/j.clgc.2022.11.020