Abstract
Background: Clinical treatment guidelines for metastatic castration-resistant prostate cancer (mCRPC) predominantly rely on the evidence from clinical trials, which frequently apply restrictive eligibility criteria resulting in selected patient populations. Therefore, real world treatment pattern may deviate from recommendations. We aimed to describe treatment patterns including sequencing and treatment duration of patients diagnosed with mCRPC in Germany, by characterizing the demographic and clinical characteristics of patients. Methods: A large German claims database was used to identify males who were diagnosed and treated for mCRPC (ICD-10-GM code C61) between January 2013 and December 2015. Patients were required to be continuously enrolled 12 months before initiation of treatment with abiraterone, cabazitaxel, docetaxel, or enzalutamide. Study endpoints included lines of therapy, treatment duration and treatment sequencing. Treatment duration was calculated via Kaplan-Meier estimates. Results: There were n=447 patients meeting all inclusion criteria in the database. Mean age (±SD) was 72.9 (±8.8) years, mean Charlson comorbidity index was 8.1, there were on average 1.9 hospitalizations within the 12 months before the index, and 70% of patients presented with bone metastasis. Overall, abiraterone was the most commonly prescribed treatment across lines of therapy while cabazitaxel, was the least utilized therapy. The longest treatment duration was seen in abiraterone patients (median duration of 8.3 months in first and 7.4 months in second line). Switches between abiraterone and docetaxel in first and second line were common. Among the 447 patients more than 70 different pathways were identified. Conclusion: There was a significant variability in treatment pathways pointing to a highly individualized treatment approach in spite of detailed treatment algorithms. Even in third line, systemic therapies were still being prescribed. Furthermore, this study showed that routine-care data are a valuable source to assess the actual treatment pathways on a cohort but also on an individual level.
Highlights
Clinical treatment guidelines for metastatic castration-resistant prostate cancer predominantly rely on the evidence from clinical trials, which frequently apply restrictive eligibility criteria resulting in selected patient populations
Mean age (±Standard Deviation (SD)) was 72.9 (±8.8) years, mean Charlson comorbidity index was 8.1, there were on average 1.9 hospitalizations within the 12 months before the index, and 70% of patients presented with bone metastasis
Patients receiving docetaxel were younger at index, than those receiving abiraterone and enzalutamide
Summary
Clinical treatment guidelines for metastatic castration-resistant prostate cancer (mCRPC) predominantly rely on the evidence from clinical trials, which frequently apply restrictive eligibility criteria resulting in selected patient populations. Patients were required to be continuously enrolled 12 months before initiation of treatment with abiraterone, cabazitaxel, docetaxel, or enzalutamide. Thanks to Germany’s statutory screening program, the majority of cases are diagnosed at early stages (T1 and T2) which, together with effective treatment options involving hormone deprivation, external-beam radiation and surgery, explain the persistent decline in age-adjusted mortality rates over the past twenty years [2, 3]. Many of those patients progress into more severe stages [1]. By 2013, enzalutamide was added to the available treatment options (post-chemo in June 2013 and pre-chemo in December 2014) together with radium223 for pre and post chemotherapy (December 2013) [8]
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