scholarly journals Modern drug therapy of prostate cancer through the example of Moscow

2019 ◽  
Vol 15 (2) ◽  
pp. 77-85 ◽  
Author(s):  
K. I. Polyakova ◽  
A. G. Fisun ◽  
A. V. Govorov ◽  
V. S. Krysanova ◽  
D. A. Andreev ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Cost Effective ◽  
Androgen Deprivation ◽  
Annual Increment ◽  
Study Objective ◽  
Castration Resistant ◽  
Number Of Patients ◽  
Oncological Diseases ◽  
Using Data

Background. The average annual increment (5,09 %) of the prostate cancer (PC) incidence was highest across male oncological diseases registered in Russia from 2007 to 2017. 4643 new cases of PC were diagnosed in Moscow in 2017. As of 1st January 2018, the total number of living males with PC registered within Moscow healthcare system was 31,567.The study objective was to obtain the structure of factual costs related to medicine therapy of PC covered by the budget funds of the Moscow Healthcare Department in 2016–2017, that would help to further improve the system of subsidized drug provision for Moscow residents.Materials and methods. Using data from the information database of the Center for Medicine Provision of the Moscow City Department of Healthcare the following parameters were determined: total sum of expenses on drug purchase, mean treatment cost per 1 patient, number of patients receiving therapy, number of prescriptions, number of prescribed drug packs, mean pack cost, and others. The analyzed medicines were classified based on pharmacological and clinical groups. Costs for each class of therapies were studied.Results. During studied period (2016–2017), the most funds in Moscow were spent on abiraterone and goserelin. In 2016–2017, the amounts of prescribed packs were highest for androgen deprivation therapy: luteinizing hormone-releasing hormone agonists – goserelin and buserelin. In the group comprising 10 therapeutic regimens associated with highest costs, the percentages of costs for hormonal therapy and chemotherapy were respectively as following: 80 % and 16 % in 2016 and 75 % and 23 % in 2017. In the simplified model of costs associated with androgen deprivation therapy and treatment of metastatic castration-resistant PC without consideration of androgen deprivation therapy constituted 39 % and 61 % in 2016 and 36 % and 64 % in 2017. In the population of patients with prostate cancer, zoledronic acid, abiraterone, docetaxel, cabazitaxel were the most used medications in 2017 and the rate of enzalutamide usage was lowest.Conclusion. The highest costs are associated with treatment of metastatic castration-resistant PC. There is a growing necessity for improvement of funds spending on medications for patients with castration-resistant PC. This improvement could be achieved through development of medical methodologies that facilitate the selection of the most cost-effective approaches for early diagnosis and treatment.

scholarly journals Next-generation androgen receptor inhibitors in non-metastatic castration-resistant prostate cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592097813
Author(s):  
Pernelle Lavaud ◽  
Clément Dumont ◽  
Constance Thibault ◽  
Laurence Albiges ◽  
Giulia Baciarello ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Next Generation ◽  
Castration Resistant Prostate Cancer ◽  
Free Survival ◽  
Castration Resistant ◽  
Recent Advances

Until recently, continuing androgen deprivation therapy (ADT) and closely monitoring patients until evolution towards metastatic castration-resistant prostate cancer (CRPC) were recommended in men with non-metastatic CRPC (nmCRPC). Because delaying the development of metastases and symptoms in these patients is a major issue, several trials have investigated next-generation androgen receptor (AR) axis inhibitors such as apalutamide, darolutamide, and enzalutamide in this setting. This review summarizes the recent advances in the management of nmCRPC, highlighting the favourable impact of next-generation AR inhibitors on metastases-free survival, overall survival and other clinically meaningful endpoints.

scholarly journals Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer

2015 ◽  
Vol 33 (11) ◽  
pp. 1243-1251 ◽  
Author(s):  
Sean O'Farrell ◽  
Hans Garmo ◽  
Lars Holmberg ◽  
Jan Adolfsson ◽  
Pär Stattin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cardiovascular Disease ◽  
Androgen Deprivation Therapy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Androgen Deprivation ◽  
Gnrh Agonists ◽  
Cvd Risk ◽  
Comparison Cohort ◽  
Using Data

Purpose Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent. Methods By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models. Results From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort. Conclusion Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

scholarly journals Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

2019 ◽  
pp. 1-8
Author(s):  
Nikinaz Ashrafi Shahmirzadi ◽  
Pardis Zaboli ◽  
Monireh Afzali ◽  
Bereket Molla Tigabu ◽  
Mirhamed Hajimiri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cost Effective ◽  
Bibliographic Databases ◽  
Economic Evaluations ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Radium 223 ◽  
Number Of Patients ◽  
Effective Option

Background and Objectives: Prostate cancer is an ever-increasing global incidence and has become the fifth leading cause of cancer-related mortality in men. A significant number of patients with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC). There are a few second-line treatment options for patients with post-docetaxel mCRPC. This systematic review aimed to assess the cost-effectiveness of cabazitaxel for the treatment of mCRPC. Materials and Methods: Electronic bibliographic databases including: PubMed/Medline, NICE, CRD, and Scopus were searched in January 2018 for identifying full economic evaluations published in English and Persian. The risk of assessment bias and descriptive analyses of individual studies’ findings were presented. Results: Three articles that fulfilled the inclusion criteria were included in the current study. All the included records had a reasonable quality. Cabazitaxel was not recommended as the most cost-effective option for the treatment of docetaxel-refractory mCRPC. Abiraterone acetate and radium-223 were the recommended cost-effective treatments for mCRPC treatment. Conclusion: We found that, in general, while cabazitaxel had equal or slightly higher improvement in Quality-adjusted Life Year (QALY) as compared to the alternatives, it incurred a high cost. Despite the inclusion of a few studies in this review, cabazitaxel was not found to be a cost-effective option. Therefore, we recommend full economic evaluations to be conducted in this area.

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