Real-World Use of Androgen-Deprivation Therapy: Intensification Among Older Canadian Men With de Novo Metastatic Prostate Cancer

Author:

Wallis Christopher J D1ORCID,Malone Shawn2,Cagiannos Ilias3ORCID,Morgan Scott C2ORCID,Hamilton Robert J4,Basappa Naveen S5,Ferrario Cristiano6,Gotto Geoffrey T7,Fernandes Ricardo8,Niazi Tamim9,Noonan Krista L10,Saad Fred11,Hotte Sebastien J12,Hew Huong13,Chan Katherine F Y13ORCID,Wyllie Laura Park13,Shayegan Bobby14ORCID

Affiliation:

1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

2. Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

3. Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

4. Department of Surgery, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada

5. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada

6. Department of Oncology, McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada

7. Department of Surgery, Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada

8. Division of Medical Oncology, London Regional Cancer Program, London, ON, Canada

9. Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada

10. BC Cancer Agency, University of British Columbia, Surrey, BC, Canada

11. Genitourinary Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montréal, QC, Canada

12. Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada

13. Medical Affairs, Janssen Inc, Toronto, ON, Canada

14. Institute of Urology, St Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

Abstract

Abstract Background Despite the wealth of evidence demonstrating the efficacy of treatment intensification beyond androgen-deprivation therapy (ADT) among patients with de novo metastatic castration-sensitive prostate cancer (mCSPC), little is known of its real-world use. This study examined the real-world uptake of ADT treatment intensification among older men in a large Canadian province. Methods We performed a retrospective population-based cohort study using province-wide linked administrative data in Ontario, Canada. Patients 66 years of age and older with de novo mCSPC were included and their treatment with conventional ADT-based regimens, ADT plus next-generation androgen receptor axis–targeted therapy, and ADT plus docetaxel were identified and stratified by time. Results From 2014 to 2019, 3556 patients were identified with de novo mCSPC. Most patients (n = 2794 [78.6%]) were treated with a conventional ADT regimen, whereas 399 (11.2%) patients received ADT intensification with docetaxel and 52 (1.5%) patients received abiraterone acetate plus prednisone. In a time-stratified analysis of ADT intensification before and after the pivotal AA+P trial (LATITUDE), AA+P uptake increased from 0.5% to 3.0%, whereas docetaxel use dropped from 12.0% to 10.0%. The median survival of the study population was 18 months (interquartile range = 10-31). Conclusions The majority of patients with de novo mCSPC are treated with ADT alone in the Canadian real-world setting, despite randomized clinical trial evidence of benefit with the use of ADT-intensified regimens. As ADT treatment intensification is substantially underused, better understanding of the barriers to treatment and targeted education to address them are needed.

Funder

Janssen Inc

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

Reference26 articles.

1. Recent trends in prostate cancer in Canada;LeBlanc;Health Rep,2019

2. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer;Sweeney;N Engl J Med,2015

3. Impact of age at diagnosis of de novo metastatic prostate cancer on survival;Bernard;Cancer,2020

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