Pharmacoeconomic aspects of using enzalutamide for treatment of patients with nonmetastatic castration-resistant prostate cancer

Background. Prostate cancer is one of the most common malignant diseases among men. Until recently, the most common treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC) in Russia was to continue previously started hormonal therapy. Enzalutamide is a second-generation anti-androgen indicated for treatment of CRPC, regardless of a patient’s metastatic status, which significantly increases metastasis-free survival in nmCRPC compared with androgen deprivation therapy (ADT).Objective: to evaluate the incremental cost-effectiveness ratio (ICER) of enzalutamide use in patients with nmCRPC and the ICER of abiraterone as the first-line therapy for mCRPC from the Russian healthcare system perspective.Materials and methods. Standard ADT regimens for nmCRPC were used as a comparator as it was the only approved treatment for nmCRPC in Russia. We proposed a Markov model of CRPC progression on enzalutamide plus ADT (hereinafter enzalutamide) or ADT based on PROSPER trial data. Model was used to calculate progression-free life years and costs of nmCRPC and post-progression CRPC treatment. Simulation period was 5 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for abiraterone plus ADT and prednisolone (hereinafter abiraterone) vs ADT + prednisolone in the first-line therapy of metastatic CRPC (mCRPC) as a benchmark. In both cases, time to disease progression over a 5-year period was used as an efficacy criteria.Results. According to the Markov model, progression-free life-years gained for enzalutamide were 3.12 years compared to 1.79 for ADT within a 5-year period. The average enzalutamide therapy costs were 7,989,475.8 rubles/1 patient for 5 years, which were 5,716,983.5 rubles higher than when using ADT (2,272,492.3 rubles). ICER for enzalutamide (vs ADT) was 4,307,136.3 rubles per one progression-free life-year gained. ICER for abiraterone in the first line of mCRPC treatment (vs ADT + prednisolone) was 6,191,617.4 rubles per one progression-free life-year gained.Conclusion. In the Russian healthcare system, ICER for enzalutamide in nmCRPC was 4,307,136.3 rubles and the ICER for abiraterone in mCRPC was 6,191,617.4 rubles.

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Prognostic impact of prior local therapy in castration-resistant prostate cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyab019 ◽

2021 ◽

Author(s):

Mikifumi Koura ◽

Masaki Shiota ◽

Shohei Ueda ◽

Takashi Matsumoto ◽

Satoshi Kobayashi ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Local Therapy ◽

Progression Free Survival ◽

Castration Resistant Prostate Cancer ◽

First Line ◽

Free Survival ◽

First Line Therapy ◽

Castration Resistant ◽

Line Therapy

Abstract Objective This study aimed to reveal the prognostic values of prior local therapy in first-line therapy using androgen receptor-axis targeting agents (abiraterone or enzalutamide) or docetaxel for castration-resistant prostate cancer (CRPC). Methods The study included 303 patients treated with first-line therapy for non-metastatic and metastatic CRPC. The association between prior local therapy and therapeutic outcome including progression-free survival and overall survival was investigated by univariate and multivariate analyses as well as propensity score-matched analysis. Results In univariate analysis, local prior therapy was associated with a lower risk of all-cause mortality (hazard ratio, 0.56, 95% confidence interval, 0.40–0.79; P = 0.0009). Overall survival, but not progression-free survival, was better among patients with prior local therapy compared with patients without prior local therapy even after multivariate analysis and propensity score-matched analysis. Conclusions This study robustly indicated that prior local treatment was prognostic for overall survival among patients with CRPC. This finding is useful to predict patient prognosis in CRPC.

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647P Clinical implications of intraductal carcinoma of the prostate sub-patterns in metastatic castration-resistant prostate cancer patients treated with abiraterone or docetaxel as the first-line therapy

Annals of Oncology ◽

10.1016/j.annonc.2020.08.906 ◽

2020 ◽

Vol 31 ◽

pp. S529

Author(s):

W. Zhipeng ◽

S. Zhu ◽

J. Chen ◽

J. Zhao ◽

X. Zhang ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Intraductal Carcinoma ◽

Clinical Implications ◽

Castration Resistant Prostate Cancer ◽

First Line ◽

Carcinoma Of The Prostate ◽

First Line Therapy ◽

Castration Resistant ◽

Line Therapy

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PROPEL: A randomized phase III trial evaluating the efficacy and safety of olaparib combined with abiraterone as first-line therapy in patients with metastatic castration-resistant prostate cancer (mCRPC)

European Urology Supplements ◽

10.1016/s1569-9056(19)31321-1 ◽

2019 ◽

Vol 18 (1) ◽

pp. e1824

Author(s):

N.W. Clarke ◽

A.J. Armstrong ◽

A. Thiery-Vuillemin ◽

M. Oya ◽

D. Ye ◽

...

Keyword(s):

Prostate Cancer ◽

Phase Iii ◽

Efficacy And Safety ◽

Castration Resistant Prostate Cancer ◽

First Line ◽

Phase Iii Trial ◽

First Line Therapy ◽

Castration Resistant ◽

Line Therapy

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Taxane chemotherapy vs antiandrogen agents as first-line therapy for metastatic castration-resistant prostate cancer

BJU International ◽

10.1111/bju.14152 ◽

2018 ◽

Vol 121 (6) ◽

pp. 871-879 ◽

Cited By ~ 6

Author(s):

Guru Sonpavde ◽

Ahong Huang ◽

Li Wang ◽

Onur Baser ◽

Raymond Miao

Keyword(s):

Prostate Cancer ◽

Castration Resistant Prostate Cancer ◽

First Line ◽

First Line Therapy ◽

Castration Resistant ◽

Line Therapy ◽

Taxane Chemotherapy

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The Heterogeneity of Intraductal Carcinoma of the Prostate Is Associated With Different Efficacy of Standard First-Line Therapy for Patients With Metastatic Castration-Resistant Prostate Cancer

10.21203/rs.3.rs-130873/v1 ◽

2020 ◽

Author(s):

Zhipeng Wang ◽

Sha Zhu ◽

Jinge Zhao ◽

Ling Nie ◽

Xueqin Chen ◽

...

Keyword(s):

Prostate Cancer ◽

Therapeutic Efficacy ◽

Progression Free Survival ◽

Castration Resistant Prostate Cancer ◽

First Line ◽

Free Survival ◽

Carcinoma Of The Prostate ◽

First Line Therapy ◽

Castration Resistant ◽

Line Therapy

Abstract BackgroundTo explore whether patients with distinct intraductal carcinoma of the prostate (IDC-P) subtypes respond differently to standard first-line therapy among patients with metastatic castration resistant prostate cancer (mCRPC).MethodsWe retrospectively analyzed data of 170 mCRPC patients receiving abiraterone (ABI) or docetaxel (DOC) as first-line therapy between 2014 and 2019. PSA response, PSA progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed and compared based on the presence of IDC-P and its sub-patterns.ResultsTotally, IDC-P was confirmed in 91/170 (53.5%) patients. Among them, 36/91 (39.6%) and 55/91 (60.4%) harbored IDC-P pattern 1 and pattern 2, respectively. The presence of IDC-P was confirmed to be associated with poor prognosis in the whole cohort. Patients with IDC-P pattern 1 shared similar clinical outcomes to those without IDC-P in both ABI and DOC treatment. However, compared to patients with IDC-P pattern 1 and without IDC-P, IDC-P pattern 2 had markedly poorer prognosis in either ABI (PSA-PFS: P<0.001; rPFS: P<0.001) or DOC (PSA-PFS: P<0.001; rPFS: P<0.001) treatment. For patients without IDC-P, DOC had comparable therapeutic efficacy with ABI. In contrast, the therapeutic efficacy of DOC in patients with either IDCP pattern 1 (PSA-PFS: P=0.021; rPFS: P=0.027) or pattern 2 (PSA-PFS: P=0.003; rPFS: P=0.007) was significantly inferior to ABI.ConclusionCompared to DOC, ABI exhibited better efficacy in patients with IDC-P of either pattern. However, IDC-P pattern 2 still responded unsatisfactorily to either ABI or DOC therapy. Novel therapeutic strategies appropriate for IDC-P pattern 2 need to be further investigated in the future.

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