scholarly journals 662P Genomic/genetic testing (GT) patterns for patients with metastatic castrate-resistant prostate cancer (mCRPC): Interim results from a real-world study in Europe (EU5)

2020 ◽  
Vol 31 ◽  
pp. S535
Author(s):  
A. Leith ◽  
A. Ribbands ◽  
A. Gayle ◽  
S. Payne ◽  
C. McCrea ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Genetic Testing ◽  
Real World ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

Radium-223 in the treatment of metastatic castrate-resistant prostate cancer: A real-world Irish experience.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 228-228
Author(s):  
Niamh Peters ◽  
John Gaffney ◽  
Emma Connolly ◽  
Richard Bambury ◽  
Derek Gerard Power ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Alkaline Phosphatase ◽  
Real World ◽  
Median Number ◽  
Prior Chemotherapy ◽  
Factors Associated ◽  
Radium 223 ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

228 Background: Radium 223 (Ra-223) has been successfully utilised in the trial setting for the treatment of men with metastatic castrate resistant prostate cancer (mCRPC). To date, no real world outcomes from its use in the Irish population have been described. Methods: From September 2016 to March 2019, data from men referred for Ra-223 treatment at our institution was retrospectively collected. We recorded patient characteristics, treatments received and outcomes. Overall Survival (OS) was analysed using the Kaplan-Meier method. Results: 81 men were referred for Ra 223. Complete data was available for 56 men. Median age was 75. 79%(45/56) had over 6 bone metastases and 21%(12/56) had lymph node involvement. The median number of prior systemic treatments for mCRPC was 2. 84%(47/56) of patients were previously treated with Androgen deprivation therapy (ADT); 48%(27/56) Abiraterone, 36%(20/56) Docetaxel, 45%(25/56) Enzalutamide and 9%(5/56) Cabazitaxel. All patients were receiving bone protection agents; 57%(32/56) Zolendronic acid and 43%(24/56) Denosumab. Median ECOG was 1 at the start of treatment and 2 at completion. The median number of treatments received was 4 with 36%(20/56) completing all 6 treatments. The most common toxicity seen was grade1 fatigue occurring in10% (6/56). 17% (10/56) required a blood transfusion during their treatment course. 53%(30/56) required opioid analgesia prior to Ra 223 treatment. 76% of these men (22/30) described improved pain following Rad-223. At a median follow up of 13 months,41%(23/56) were alive. The median OS for the entire group was 7 months. Factors associated with improved OS included ECOG 0-1,fewer than 6 bone metastases, normal alkaline phosphatase level at start of treatment and no prior chemotherapy use. Median OS for those who had not received prior chemotherapy was significantly better than those who had (9 vs 5 months p=0.04). Conclusions: This real world study demonstrates Ra 223 is a well tolerated palliative treatment amongst Irish men with mCRPC. Good performance status, lower alkaline phosphatase, chemotherapy naivety and a low burden of metastatic disease are factors associated with an improved overall survival.

Racial disparities in utilization and effectiveness of first-line therapies in metastatic castrate-resistant prostate cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17541-e17541
Author(s):  
Mallika Marar ◽  
Ronac Mamtani ◽  
Vivek Narayan ◽  
Neha Vapiwala ◽  
Ravi Bharat Parikh
Keyword(s):  
Prostate Cancer ◽  
Racial Disparities ◽  
Real World ◽  
Progression Free Survival ◽  
White Men ◽  
First Line ◽  
Free Survival ◽  
All Cause Mortality ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

e17541 Background: Prospective evidence suggests that abiraterone use is associated with improved progression-free survival in African-American (AA) men with metastatic castrate-resistant prostate cancer (mCRPC) compared to white men. It is unclear whether race-based differences in treatment utilization and effectiveness exist for men with newly diagnosed mCRPC treated in real-world clinical practice. Methods: In this retrospective cohort study, we used the Flatiron Health electronic health record-derived de-identified database to identify patients with mCRPC who received first-line (1L) systemic therapy between 2012 and 2018. We used multivariable logistic regression analysis to examine differences in utilization of abiraterone, enzalutamide, and docetaxel between AA and white men. We then used Fine-Gray models with death as a competing risk to assess treatment-specific associations between race and time to next therapy (TTNT) – a proxy for progression-free survival. Finally, we used multivariable Cox proportional hazards analyses to assess for treatment-specific racial disparities in all-cause mortality. All analyses were adjusted for age, Elixhauser comorbidity index, baseline steroid or opioid use (a proxy for disease aggressiveness), performance status, insurance status, and (if significant) an interaction term for race and age. Results: Of 3,808 mCRPC patients in the cohort, 2,165 (68.7%) were white and 404 (10.6%) were AA. At time of metastatic diagnosis, AA men were younger (69 vs. 75, p < 0.001) and more likely to have PSA value greater than 50 (57.9% vs. 42.6%, p < 0.001) compared to white men. Median follow up was 15 months. There were no significant racial differences in 1L utilization, TTNT, or all-cause mortality associated with abiraterone, enzalutamide, or docetaxel use (Table). Conclusions: In this large real-world analysis of men with mCRPC who received 1L therapy, we found no significant treatment-specific differences in utilization, TTNT, or all-cause mortality between AA and white men. Long-term prospective evidence is needed to justify differential treatment selection for AA men with mCRPC. [Table: see text]

Genomic/genetic testing patterns for patients with metastatic castrate-resistant prostate cancer: Results from a real-world study in the United States.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 49-49
Author(s):  
Andrea Leith ◽  
Amanda Ribbands ◽  
Matthew Last ◽  
Alicia Gayle ◽  
Sarah Payne ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Genetic Testing ◽  
Real World ◽  
Patient Characteristics ◽  
The United States ◽  
Molecular Testing ◽  
Cancer Disease ◽  
The Us ◽  
Castrate Resistant

49 Background: In May 2020, Olaparib was approved for HRRm mCRPC post progression on abiraterone and enzalutamide, and rucaparib was approved for BRCAm mCPRC following progression on androgen receptor targeted inhibitors and prior taxane therapy for mCRPC. HRRm are associated with approximately 25% of mCRPC and may be derived from germline or somatic origin. Somatic and germline alterations can be detected by tumour testing, but to differentiate between these, independent germline testing is needed. This study examined real-world genomic/genetic testing (GT) patterns in patients (pts) diagnosed with mCRPC in the United States (US). Methods: Data were drawn from the Adelphi Prostate Cancer Disease Specific Programme; a point-in-time survey administered to oncologists (onc), urologists (uro) and surgeons (sur) between January and August 2020 in the US. Physicians (phys) completed an attitudinal survey and a patient record form for the next four to nine mCRPC pts seen. Study variables included patient demographics, clinical factors and GT patterns. HRRm testers were defined as phys who tested for HRRm. Pts were identified as positive, negative or unknown depending on the outcome of the HRRm test. Results: A total of 72 phys (69% onc/ 29% uro/ 1% sur; 40% academic vs. 60% community) reported on 346 mCRPC pts. 41% of phys were based in the Northeast, 24% Midwest, 23% South and 13% in the West region of the US. 65 phys (90%) reported having access to overall GT; of these 5% identified as having access to germline tests only, while 94% were able to test for germline and somatic mutations. Challenges to conducting GT overall were ‘cost per test’ (50%), ‘having to send out for the tests (within country)’ (25%), ‘inadequate sample available’ (25%) and ‘patient refusal’ (25%). GT was typically conducted at identification of castrate-resistance (52%), metastases (51%) and at initial diagnosis (49%). 72% of total phys were HRRm testers; for these, patient characteristics primarily driving HRRm testing included Ashkenazi Jewish heritage (63%) and ECOG of 2-4 (58%). Other common drivers were family history, young diagnosis age and hormone therapy failure (all 46%). 132 (38% of 326) mCRPC pts were tested for HRRm; 39% of tested pts were identified with a HRRm. Most common HRRm tested were BRCA1 (90%), BRCA2 (89%) and ATM (55%). Conclusions: In this study majority of US phys had access to GT, but testing was only performed in 38% of pts with mCRPC. The higher than expected % of pts identified with an HRRm suggest that molecular testing was prioritised in high risk populations, as identified by the phys. With the recent approval of olaparib and rucaparib, GT may become more routine in clinical practice to identify eligible pts. Broader testing may also depend on addressing other barriers to testing including cost and testing logistics/practicalities.

scholarly journals Real-world Outcomes and Factors Predicting Survival and Completion of Radium 223 in Metastatic Castrate-resistant Prostate Cancer

2018 ◽  
Vol 30 (9) ◽  
pp. 548-555 ◽  
Author(s):  
S. Parikh ◽  
L. Murray ◽  
L. Kenning ◽  
D. Bottomley ◽  
O. Din ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Radium 223 ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

Veterans affairs (VA) prostate cancer treatment (Tx) sequencing (VAPCaTS): A real-world study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 54-54
Author(s):  
Stephen J. Freedland ◽  
Amanda M. De Hoedt ◽  
Maral DerSarkissian ◽  
Rose Chang ◽  
Ambika Satija ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Risk Scores ◽  
Real World Data ◽  
Prostate Cancer Treatment ◽  
Optimal Outcomes ◽  
Castrate Resistant Prostate Cancer ◽  
Hormone Sensitive ◽  
Castrate Resistant

54 Background: Limited real-world data are available on tx sequence for patients (pts) with metastatic hormone-sensitive PC (mHSPC) treated with androgen deprivation therapy (ADT) plus docetaxel (D) or abiraterone (A) who progress to metastatic castrate-resistant prostate cancer (mCRPC). Methods: VA electronic medical records were used to retrospectively analyze 240 men treated for mHSPC with ADT and D (n=208; selected to be overrepresented) from 07/2014-08/2018 or ADT and A (n=32) from 12/2016-09/2018 and receiving at least one tx after progressing to mCRPC. Results: For D and A cohorts respectively, median age at mHSPC diagnosis was 65.2 and 70.8 yrs; 62% and 77% were white; 98% and 100% had bone metastases (mets), 40% and 34% had lymph node mets, 21% and 16% had lung mets, and 20% and 6% had liver mets; median follow-up after ADT start was 2.2 and 1.4 yrs. Pts in D and A cohorts had 56% and 36% low, 33% and 45% intermediate, and 11% and 19% high Halabi risk scores at mCRPC, respectively. Among all pts, max mCRPC tx lines was 6; 106 (44%) had only one line, 71 (30%) had two lines, and 63 (26%) pts had ≥ three lines. Across all mCRPC tx lines, 71 (30%) received a taxane at some point (47 D, 40 cabazitaxel [C]). Txs for first and second line mCRPC are shown in the Table. For D pts who received androgen-receptor targeted agents (ARTA) as first mCRPC tx and received any second mCRPC tx, 70 (62%) were treated with back-to-back ARTA. For A pts, 25 (78%) received back-to-back ARTA as first mCRPC tx. Conclusions: Most pts received ARTA as first mCRPC tx, and a large proportion of pts were treated with back-to-back ARTA. Longer follow-up is needed to assess which sequences are associated with optimal outcomes.[Table: see text]

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