Bone modifying agents (BMAs) prevent skeletal related events among patients with metastatic, castration-resistant prostate cancer (mCRPC) involving bone and prevent osteoporotic fractures among patients at high risk. BMA utilization for patients with mCRPC has not been well quantified.
We used linked SEER registry and Medicare claims data. We included men diagnosed with stage IV prostate adenocarcinoma during 2007–2015, aged > = 66 at diagnosis, with sufficient continuous enrollment in Medicare Parts A, B, and D, who received androgen deprivation therapy. We limited to those who subsequently received a CRPC-defining treatment (CDT). We identified patients with evidence of bone metastasis using claims. Our primary outcome was receipt of a BMA (zoledronic acid or denosumab) within 180 days of initiating CDT.
Among 1292 included patients, 1034 (80%) had bone metastasis. BMA use within 180 days of initiating CDT was higher among patients with bone metastases than those without (705/1034 [68%] vs 56/258 [22%]). Among patients without bone metastasis, those with high osteoporotic fracture risk were more likely than those without to receive a BMA (OR = 2.48, 95% CI: 1.17, 5.29); however, only 26% of patients with high fracture risk received a BMA. Among patients who received BMAs, most (62%) first initiated them >90 days before initiating CDT.
Two-thirds of patients with mCRPC and bone metastases received BMAs within 180 days after initiating CDT. A greater proportion of patients without bone metastasis may warrant BMA therapy for osteoporotic fracture prevention. Some patients with bone metastasis may be able to delay BMA initiation until CRPC.
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The data underlying this article were provided by the Centers for Medicare and Medicaid Services (CMS) under license. Data are available from CMS on request and establishment of data use agreement.
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This work was supported by the National Cancer Institute at the National Institutes of Health [grant numbers 1R03CA259863-01 to A.P.M, and P30CA008748]. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
APM and AS have no potential conflicts of interest to disclose. AMM declares stock ownership in Johnson & Johnson, DNA, and Teladoc Health. KP declares stock ownership in T2 Biosystems, Adicet Bio, Inc., Chinook Therapeutics, Codexis, and Vincerx Pharma. AF declares consulting for Amgen. MM declares consulting and/or advisory arrangements with Bayer, Novartis, Advanced Accelerator Applications, ORIC Pharmaceuticals, Johnson & Johnson, Curium Pharma, Athenex, Exelixis, AstraZeneca, and Amgen, paid travel for Endocyte and Fujifilm, and research funding from Bayer, Sanofi, Endocyte, Progenics, Corcept Therapeutics, Roche/Genentech, and Janssen.
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Mitchell, A.P., Meza, A.M., Panageas, K.S. et al. Real-world use of bone modifying agents in metastatic, castration-resistant prostate cancer. Prostate Cancer Prostatic Dis (2022). https://doi.org/10.1038/s41391-022-00573-y