Sequencing of treatments in metastatic CRPC for patients who have completed all therapeutic interventions.

Abstract

339 Background: The current treatment paradigm for metastatic, castrate-resistant prostate cancer (mCRPC) has rapidly changed and six therapies [abiraterone (Abi), enzalutamide (Enza), docetaxel (Doc), cabazitaxel (Cab), radium-223 (Ra-223), and sipuleucel-T (Sip-T)] have now been proven to prolong overall survival. Though sequential therapy is the norm, few studies have reported on the variety and prevalence of these agents over the course of patient's lifetime. Herein, we sought to describe the temporal frequencies of mCRPC therapies in patients who completed all of their therapies. Methods: Retrospective chart reviews were conducted on 119 patients who died from mCRPC at Tulane Cancer Center from 2008-2015 (thus completing all possible therapies). Many patients were not treated with multiple life-prolonging therapies given the timing of their death. Post-mCRPC therapies were longitudinally sequenced and a frequency table was generated for first, second, third, etc. line of therapies. Results: Median duration from initial androgen deprivation therapy to mCRPC was 29 months (range: 0-252) and 34.4% of the cohort presented with distant metastatic disease (M1) at diagnosis. The most common front line mCRPC therapies were nilutamide, Doc, Abi, and ketoconazole (Keto) in that order. Keto, Doc, dexamethasone, and Abi were the most common second line therapies. Abi, Doc, DES, and Cab were the most prevalent third line therapies. Doc, Abi, Cab, and Ra-223 were most common fourth line therapies. The median overall survival for our cohort was 69 months (range: 5-270 months) from initial diagnosis. Conclusions: This retrospective analysis provides a temporal snapshot of the timing and frequency of treatments for men dying from mCRPC from 2008-2015. More recent patients are likely to have greater access to contemporary therapies.