Clinical outcomes associated with pathogenic genomic instability mutations in prostate cancer: a retrospective analysis of US pharmacy and medical claims data

17 Background: Prostate cancer incidence and mortality is higher in African American (AA) as compared with non-AA men. The outcomes of mCSPC have significantly improved through treatment intensification yet, AA representation in those studies was suboptimal. We aimed to report the clinical, treatment outcomes and genomic data of AA men with mCSPC. Methods: Retrospective analysis of consecutive AA men with mCSPC at six Academic Institutions. The primary objective was to report the baseline characteristics and treatment patterns of mCSPC AA patients. The secondary objectives included the germline and somatic data and the clinical outcomes including PSA response, progression-free survival and subsequent treatments. Results: A total of 71 patients, median age 63 years (range, 41-84) with 58% Gleason 8-10, initial PSA of 69.8 ng/mL (0.02-7650), 59% with de-novo and 55% with high-volume (CHAARTED criteria; 20% visceral) disease, were included in this analysis. Twenty-two patients (31%) were treated with androgen deprivation therapy (ADT; 67% prior to year 2017), while 24%, 45% and 3% received docetaxel (median 6 cycles), abiraterone acetate and enzalutamide, respectively. Two patients received triplet therapy with ADT/docetaxel plus abiraterone or enzalutamide. Undetectable PSA was achieved in 35% after a median of 8.9 months (1.8-22.3). Among patients with mCSPC who received radiation therapy to prostate (n = 8), 89% had low volume disease. At time of cut off, thirty-two patients developed CRPC and the estimated median time to CRPC was 2.9 years (95% CI, 1.6-4.2). Subsequent therapies (n = 29) included abiraterone acetate (41%), enzalutamide (24%), bicalutamide (10%), radium-223 (7%), chemotherapy (7%), sipuleucel-T (3%) and others (7%). Five patients (8%) had pathogenic germline alterations (n = 2 BRCA1; n = 1 HOXB13, PALB2 and PMS2). Additionally, the most common somatic alterations among tested patients (n = 27) included CDK12, SPOP, TMPRSS2-ERG fusion, and TP53, all in 11% frequency. Of note, n = 2 BRCA1 and n = 1 high MSI/TMB. Conclusions: In one of the largest reported cohorts to our knowledge, mCSPC AA presented with a high number of de-novo and high-volume disease and might harbor a different germline and somatic genomic profile. The outcomes were comparable to contemporary phase III trials with treatment intensification, yet 31% were treated with ADT. Despite the known limitations associated with retrospective analysis, these data support prior observations where AA might have better initial PSA responses to ADT-based strategies compared with Caucasians, requiring further validation.

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Provider mix and costs associated with treatment of patients with bone metastases secondary to prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15175 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15175-e15175

Author(s):

Kenneth M. Shermock ◽

Sean D Sullivan ◽

Scott David Ramsey ◽

Brian S. Seal

Keyword(s):

Prostate Cancer ◽

Bone Metastases ◽

Claims Data ◽

Treatment Patterns ◽

Pharmaceutical Treatment ◽

Medical Claims ◽

Icd9 Code ◽

Diagnostic Role ◽

Procedure Codes

e15175 Background: Treatment of patients with bone metastases secondary to prostate cancer can involve several provider types and combinations of chemotherapy, surgery, radiation, and pharmaceutical treatment. This study evaluated the combinations of provider types and associated treatment patterns for a cohort of patients with bone metastases secondary to prostate cancer. Methods: Continuously enrolled patients older than 20 years of age in the MarketScan database between January 2004 and December 2010 with evidence of bone metastases (ICD9 code 198.5 or treatment with zolderonic acid, pamidronate, or demosumab) were included. Inpatient and outpatient medical claims data were used to define provider combinations. Treatment patterns were determined from prescription fill/refill claims and procedure codes from inpatient and outpatient medical claims. Results: A total of 4,493 patients had evidence of bone metastases. A radiologist was involved in care for a vast majority (n=4,054, 90%). Less than half of the population, (n=1,751, 39%) had an oncologist actively involved in care. Most patients (n=2633, 59%) had both an urologist and a radiologist involved in their care. The most common combinations of providers were urologist and radiologist (n=998, 22%); urologist, radiologist, and surgeon (n=951, 21%), and urologist, radiologist, and oncologist (n=781, 17%). About 15% (n=684) of patients had a surgeon, urologist, oncologist, and radiologist involved in their care. Only approximately half (n=2,274, 51%) of the population had evidence of receiving radiation therapy, suggesting that the radiologist plays a diagnostic role for many patients. A vast majority of patient were prescribed hormone therapy (89%) and 76% were prescribed steroid agents (mostly glucocorticoids). Less than half of the population (n=1,838, 41%) received surgery related to their prostate cancer. Conclusions: There is significant variation in combinations of provider types and associated treatment patterns for patients who have bone metastases secondary to prostate cancer. Follow-up studies should examine optimal conditions for different provider mixes and treatment patterns.

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