Temporal and geographic variation in the systemic treatment of advanced prostate cancer

Megan E V Caram,Bhramar Mukherjee,Jennifer J Griggs,Paul Lin,Jason P Estes

doi:10.1186/s12885-018-4166-3

Megan E V Caram, Bhramar Mukherjee + Show 3 more

Open Access

https://doi.org/10.1186/s12885-018-4166-3

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Abstract

BackgroundSeveral systemic treatments have been shown to increase survival for patients with metastatic castration-resistant prostate cancer. This study sought to characterize variation in use of the six “focus drugs” (docetaxel, abiraterone, enzalutamide, sipuleucel-T, radium-223, and cabazitaxel) that have been approved by the Food and Drug Administration for the treatment of metastatic castration-resistant prostate cancer during the years 2010–2015. We hypothesized that the use of these treatments would vary over time and by region of the country.MethodsWe used Clinformatics DataMart™ Database (OptumInsight, Eden Prairie, MN), a de-identified claims database from a national insurance provider. Our sample included patients with prostate cancer who received any of the six drugs. We describe changes in usage patterns over time and geographic region of the United States via detailed descriptive statistics. We explore both patterns of first line therapy and sequence of treatments in our database.ResultsOur final analysis included 4275 patients with a mean age of 74 years. Docetaxel was the most commonly used first-line therapy in 2010 (97%), 2011 (66%), and 2012 (49%). Abiraterone was the most commonly used first-line therapy in 2013 (56%), 2014 (46%), and 2015 (34%). Approximately 14% of our study cohort received ≥3 of the 6 drugs throughout their disease course. There was marked geographic variation in use of each of the drugs.ConclusionVariation in treatment patterns were found with respect to both time and geographic location. Prescription rates of abiraterone outpaced docetaxel as the most commonly prescribed drug after 2013 when it became widely available. However, some regions of the country still lagged behind and prescribed less than would be expected.

Highlights

Several systemic treatments have been shown to increase survival for patients with metastatic castration-resistant prostate cancer
All variables were significantly different in distribution (p < 0.05) between the larger prostate cancer sample and our selected sample of patients who received any one of the focus drugs
Notable temporal patterns emerged throughout the observed period, including the declining preference of docetaxel as first-line treatment over time, likely a consequence with the approval of abiraterone in 2011, and a decline of abiraterone use when enzalutamide was Food & Drug Administration (FDA)-approved toward the end of 2012

Summary

Introduction

Several systemic treatments have been shown to increase survival for patients with metastatic castration-resistant prostate cancer. This study sought to characterize variation in use of the six “focus drugs” (docetaxel, abiraterone, enzalutamide, sipuleucel-T, radium-223, and cabazitaxel) that have been approved by the Food and Drug Administration for the treatment of metastatic castration-resistant prostate cancer during the years 2010–2015. We describe changes in usage patterns over time and geographic region of the United States via detailed descriptive statistics We explore both patterns of first line therapy and sequence of treatments in our database. The Food & Drug Administration (FDA) approved docetaxel in 2004 for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) based on. Use is likely to be influenced by whether a practice invested in the infrastructure needed to deliver these specialty medications (for example, radium-223 requires existence of a nuclear medicine facility)

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