Pattern of prescribing after disease progression following upfront docetaxel in metastatic hormone-naïve prostate cancer within the UK: Results from a national study.

Abstract

e19190 Background: Upfront docetaxel is now standard of care for men with newly diagnosed metastatic hormone naïve prostate cancer .After disease progression following upfront docetaxel, various treatment agents including further lines of chemo or novel hormonal agents are used but there have been no convincing evidence or consensus opinion about optimal sequencing. Methods: We have conducted a national study in the UK by approaching oncologists who treat prostate cancer with systemic therapies. The oncologists were requested to complete a web based survey about their treatment decisions . Aim were to gain an insight about current practice following docetaxel in the UK and to identify the various disease and patients related factors which could influence the decision-making process. Results: 114 oncologists were invited and 59 have responded, 80% clinical oncologist and 20% medical oncologists respectively. At the point of castrate-resistant disease progression, following docetaxel, abiraterone was most commonly used agents (63%), followed by Enzalutamide (29%), cabazitaxel (6%) and docetaxel re-challenge respectively. Time difference between finishing docetaxel and disease progression was considered the most important deciding factor to choose next agents. Other important factors as per responders were volume of the disease, patients current symptoms, co morbidities and site of metastases . Most oncologists felt initial PSA and Gleason scores were two least important deciding factors. Patients with low volume disease, 92 % oncologist preferred abiraterone or enzalutamide as opposed to chemotherapy. When disease progressed within 6 months of completion of docetaxel, only one fifth of responder would use further chemo in next line .After novel hormone agents, cabazitaxel was the most commonly prescribed agents. 81% of clinicians would consider re-challenging with Docetaxel at some point of treatment sequencing; of these the majority would only consider this after a minimal interval of 12-18 months following upfront treatment. Conclusions: Our study has demonstrated a wide variation of practice in the UK. It has reflected that the decision is complex and there is clear need for further evidence or guideline for sequencing.