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The effects of new life-prolonging drugs for metastatic castration-resistant prostate cancer (mCRPC) patients in a real-world population

Prostate Cancer and Prostatic Diseases volume 24, pages 871–879 (2021)Cite this article

Subjects

Abstract

Background

In 2004 docetaxel was the first life-prolonging drug (LPD) registered for metastatic castration-resistant prostate cancer (mCRPC) patients. Between 2011 and 2014 new LPDs for mCRPC (cabazitaxel, abiraterone, enzalutamide, and radium-223) were introduced in the Netherlands. The objective of this study is to assess the impact of the introduction of new LPDs on treatment patterns and overall survival (OS) over time.

Patients and methods

CRPC patients diagnosed in the years 2010–2016 in the observational, retrospective CAPRI registry (20 hospitals) were included and followed up to 2018. Two subgroups were analyzed: treatment-naïve patients (subgroup 1, n = 3600) and post-docetaxel patients (subgroup 2, n = 1355).

Results

In both subgroups, the use of any LPD increased: from 57% (2010–2011) to 69% (2014–2015) in subgroup 1 and from 65% (2011–2012) to 79% (2015–2016) in subgroup 2. Chemotherapy as first mCRPC-treatment (i.e., docetaxel) and first post-docetaxel treatment (i.e., cabazitaxel or docetaxel rechallenge) decreased (46–29% and 20–9% in subgroup 1 and 2, respectively), while the use of androgen-receptor targeting treatments (ART) increased from 11% to 39% and 46% to 64% in subgroup 1 and 2, respectively. In subgroup 1, median OS (mOS) from diagnosis CRPC increased from 28.5 months to 31.0 months (p = 0.196). In subgroup 2, mOS from progression on docetaxel increased from 7.9 months to 12.5 months (p < 0.001). After multiple imputations of missing values, in multivariable cox-regression analysis with known prognostic parameters, the treatment period was independent significant for OS in subgroup 1 (2014–2015 vs. 2010–2011 with HR 0.749, p < 0.001) and subgroup 2 (2015–2016 vs. 2011–2012 with HR 0.811, p = 0.037).

Conclusion

Since 2010, a larger proportion of mCRPC patients was treated with LPDs, which was related to an increased mOS.

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Fig. 1: Treatment patterns.
Fig. 2: Overall survival.

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Funding

This research was funded by Sanofi-Aventis Netherlands B.V., Janssen-Cilag B.V., Astellas Pharma B.V., and Bayer B.V. The funding organizations had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, and preparation, review, or approval of the abstract.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands

    H. M. Westgeest

  2. Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands

    H. M. Westgeest, M. C. P. Kuppen & C. A. Uyl-de Groot

  3. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands

    A. J. M. van den Eertwegh

  4. Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, the Netherlands

    R. de Wit

  5. Division of Internal Medicine (MOD) and Oncogenomics, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    A. M. Bergman

  6. Department of Urology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands

    R. J. A. van Moorselaar

  7. Department of Internal Medicine, Isala Klinieken, Zwolle, the Netherlands

    J. L. L. M. Coenen

  8. Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands

    A. C. M. van den Bergh

  9. Department of Urology, Canisius Wilhemina Hospital, Nijmegen, the Netherlands

    D. M. Somford

  10. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands

    N. Mehra & W. R. Gerritsen

  11. Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands

    I. M. van Oort

  12. Department for Health Evidence, Radboud University Medical Center, The Netherlands and Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands

    K. K. H. Aben

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  1. H. M. Westgeest
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Corresponding author

Correspondence to H. M. Westgeest.

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Conflict of interest

HMW reports travel expenses paid by Ipsen and honoraria from Roche and Astellas. MCPK reports travel expenses from Ipsen. AJMvdE reports study grants from Sanofi and Roche, travel expenses from MSD Oncology, Roche, Pfizer, and Sanofi, honoraria from Bristol-Myers Squibb, and consulting/advisory role for Bristol-Myers Squibb, MSD Oncology, Amgen, Roche, Novartis, Sanofi, Pfizer, Ipsen, and Merck. RdW reports consulting/advisory role for Sanofi, Merck Sharp&Dohme, Roche/Genentech, Janssen, Bayer, Clivis; honoraria from Sanofi, Merck Sharp&Dohme; and research funding from Sanofi and Bayer. AMB reports research funding from Sanofi, Astellas, and Bayer; consulting/advisory role for Sanofi, Astellas, and Bayer; travel expenses for Sanofi, Astellas, and Bayer and speakers bureau for Sanofi, Astellas, Bayer, and Janssen. RJAvM reports honoraria from Astellas, AstraZeneca, Bayer, Janssen and Sanofi-Genzyme. JLLMC reports consulting/advisory role for Sanofi. DMS reports research funding from Astellas and consulting/advisory role for Astellas and Janssen. NM reports research funding (institute) for Astellas, Janssen, Pfizer, Roche, and Sanofi Genzyme; advisory role (compensated and institutional) for Roche, MSD, BMS, Bayer, Astellas, and Janssen; and travel expenses from Astellas and MSD. IMvO reports consulting/advisory role for Astellas, Janssen, Bayer, Roche, Mdx health; and research funding from Astellas, Janssen, Bayer. WRG reports speakers fees from Bayer and MSD; consulting/advisory role for Bristol-Myers Squibb, Astellas, Bayer, Sanofi, Amgen; and research funding from Bayer, Astellas, Janssen-Cilag. CAUdG reports research funding from Boehringer Ingelheim, Astellas, Celgene, Sanofi, Janssen-Cilag, Bayer, Amgen, Genzyme, Merck, Glycostem Therapeutics, Astra Zeneca, Roche, and Merck. All remaining authors have declared no conflicts of interest.

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Westgeest, H.M., Kuppen, M.C.P., van den Eertwegh, A.J.M. et al. The effects of new life-prolonging drugs for metastatic castration-resistant prostate cancer (mCRPC) patients in a real-world population. Prostate Cancer Prostatic Dis 24, 871–879 (2021). https://doi.org/10.1038/s41391-021-00344-1

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