scholarly journals The burden of symptomatic skeletal events in castrate-resistant prostate cancer patients with bone metastases at three Canadian uro-oncology centres

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Fred Saad ◽  
Neil E. Fleshner ◽  
Alan So ◽  
Jacques Le Lorier ◽  
Louise Perrault ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Targeted Therapy ◽  
Median Time ◽  
Resource Use ◽  
Bone Disease ◽  
Healthcare Resource ◽  
Metastatic Bone Disease ◽  
Healthcare Resource Use ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

Introduction: Metastatic bone disease in castrate-resistant prostate cancer (CRPC) carries risks of significant morbidity, including symptomatic skeletal events. We estimated the healthcare resource costs of managing skeletal events. Methods: A retrospective chart review was conducted for patients who died from or were treated palliatively for metastatic CRPC from 2006–2013 at Centre Hospitalier de l’Université de Montréal (Montreal), Princess Margaret Cancer Centre (Toronto), or Vancouver General Hospital (Vancouver). Results: Of 393 patients, 275 (70%) experienced 833 events (85 per 100 patient-years), with a median time to first event of 17.6 months (95% confidence interval [CI] 15.3, 21.7). The mean metastatic bone disease-related healthcare resource use cost (2014 Canadian dollars) estimate for patients without symptomatic skeletal events was $9550 and between $22 101 (observed) and $34 615 (adjusted) for patients with at least one event. Fewer patients in Montreal (55%) experienced events compared to Toronto (79%) or Vancouver (76%). Median time to first event was longer in Montreal (25.0 months [18.5, 32.6]) than in Toronto (14.6 months [9.7, 16.8]) or Vancouver (17.3 months [14.8, 24.0]). More patients received bone-targeted therapy in Montreal (64%) and Toronto (60%) than in Vancouver (24%). Bone-targeted therapy was mostly administered every 3–4 weeks in Montreal and every 3–4 months in Toronto. Conclusions: Metastatic bone disease-related healthcare resource use costs for Canadian CRPC patients are high. Symptomatic skeletal events occurred frequently, with the incremental cost of one or more events estimated between $12 641 and $25 120. Symptomatic skeletal event incidence and bone-targeted therapy use varied considerably between three Canadian uro-oncology centres. An important limitation is that only patients who died from prostate cancer were included, potentially overestimating costs.

A phase II study to evaluate the effects of docetaxel plus lycopene in advanced castrate-resistant prostate cancer.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 77-77
Author(s):  
Eric Zhuang ◽  
Edward M. Uchio ◽  
Michael B. Lilly ◽  
John P. Fruehauf
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Median Time ◽  
Response Rate ◽  
Phase Ii Study ◽  
Duration Of Response ◽  
Psa Response ◽  
Castrate Resistant Prostate Cancer ◽  
Psa Progression ◽  
Castrate Resistant

77 Background: Lycopene, the carotenoid responsible for the red colors seen in tomatoes, grapefruit, and other foods, has demonstrated synergism with docetaxel in prostate cancer cell culture and tumor xenograft models. This phase II study investigated the clinical activity and safety profile of docetaxel plus lycopene in advanced castrate resistant prostate cancer. Methods: Eligible patients had histologically confirmed adenocarcinoma of the prostate, two rising pre-study prostate specific antigen (PSA) values ≥ 1 ng/ml, and no prior treatment with any chemotherapy, biological therapy, or investigational drug. All patients initially received docetaxel 75mg/m2 every 21 days in combination with lycopene 30 mg orally once daily. The primary endpoint was PSA response rate, defined as the proportion of subjects achieving a ≥ 50% reduction in PSA at any point after starting therapy. Secondary endpoints included median time to PSA progression, duration of response (DOR), and overall survival (OS). Results: Fourteen patients were screened, and thirteen patients were initiated on protocol therapy. Median age was 77 years (range 55-90). Twelve patients (92%) had bone metastases. Four patients (30%) had bone and visceral metastases. The PSA response rate was 76.9% [95% confidence interval (CI), 46.2-94.9], comprising of ten PSA responses. Two patients had a best response of stable disease, yielding a disease control rate of 92% [95% CI, 57.2-98.2]. Median time to PSA progression was 8 months [95% CI, 3.5-8.7]. Median duration of response was 7.3 months [95% CI, 4.8-13.2]. On 5-year follow-up, median overall survival was 35.1 months [95% CI, 25.7-57.7]. The most frequently reported ( > 15%) non-hematologic adverse events included diarrhea, nausea, vomiting, peripheral neuropathy, weight loss, fatigue, onycholysis, and alopecia. One patient (7%) experienced febrile neutropenia. No patients experienced grade 3 or above anemia. Conclusions: The combination of docetaxel with lycopene led to improved PSA response rate and tolerability in patients with advanced castrate resistant prostate cancer. Docetaxel plus lycopene merits further research in this patient population. Clinical trial information: NCT01882985.

Abstract B4: Elevated expression of c-FLIP in castrate-resistant prostate cancer antagonizes response to androgen receptor-targeted therapy

2012 ◽  
Vol 72 (4 Supplement) ◽  
pp. B4-B4
Author(s):  
Clare McCourt ◽  
Pamela Maxwell ◽  
Roberta Mazzucchelli ◽  
Manuel Salto-Tellez ◽  
Joe O'Sullivan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Targeted Therapy ◽  
Elevated Expression ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

scholarly journals The impact of targeted therapy on healthcare resource use in patients with metastatic renal cell carcinoma: The University of Sherbrooke experience

2018 ◽  
Vol 12 (9) ◽  
pp. E373-7
Author(s):  
Hugo Simard ◽  
Robert Sabbagh ◽  
Simon Ouellet ◽  
Patrick Richard ◽  
Claudio Jeldres
Keyword(s):  
Emergency Department ◽  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Resource Use ◽  
Targeted Therapies ◽  
Healthcare Resource ◽  
Therapy Group ◽  
Emergency Department Visits ◽  
Healthcare Resource Use ◽  
The Impact

Introduction: We assessed the impact of targeted therapies on healthcare resource use and compared treatment regimens used in patients diagnosed with metastatic renal cell carcinoma (mRCC).Methods: Clinicopathological and administrative data of patients with mRCC from our institution were retrospectively collected from January 2000 to August 2014. Patients were divided into two groups based on the use of targeted therapies. Healthcare resource use (HCRU) data included non-scheduled total number of hospitalizations, total days hospitalized, emergency department visits, and healthcare professional consultations. Each variable was presented with absolute and relative values (i.e., per month of survival). Statistics relied on the use of t-student and Chi-square tests.Results: Ninety-nine patients were included in the study; 60 were treated with targeted therapy. There were no statistically significant differences between the two groups for demographic features and clinicopathological stage. HCRU analysis revealed an absolute increase in the median number of healthcare consultants (6 vs. 4; p<0.01) and emergency department visits (1 vs. 0; p=0.02) for the targeted therapy group. However, analysis per month of survival showed the targeted therapy group had fewer consultants (0.33 vs. 0.40; p=0.04) and hospitalizations (0.09 vs. 0.13; p=0.03) than their counterpart. Population size, non-randomization, treatment selection bias, and heterogeneity were the main limitations of this study.Conclusions: Monthly use of HCRU is lower in mRCC patients treated with targeted therapies. However, because of a greater overall survival, their absolute total HCRU will be higher than those not exposed to targeted agents.

Prevalence of oligoprogression in metastatic hormone-resistant prostate cancer patients on androgen targeted therapies: Could targeted radiotherapy improve patient outcomes?

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 110-110
Author(s):  
Priyanka Patel ◽  
Nina Tunariu ◽  
Alison Tree
Keyword(s):  
Prostate Cancer ◽  
Median Time ◽  
Targeted Therapies ◽  
Tumour Progression ◽  
Whole Body ◽  
Electronic Patient Records ◽  
Significant Difference ◽  
Castrate Resistant Prostate Cancer ◽  
Frequent Site ◽  
Castrate Resistant

110 Background: Androgen receptor-targeted therapies (ART) such as Abiraterone and Enzalutamide have shifted the management paradigm of metastatic castrate-resistant prostate cancer (mCRPC). These treatments are well-tolerated with less toxicities compared to chemotherapy, therefore methods to delay chemotherapy are beneficial to patients. Patients eventually become resistant to ARTs, and some patients will progress in a limited number of sites. This study investigated the prevalence of oligoprogressive disease (OPD) amenable to Stereotactic-body radiotherapy (SBRT). OPD is defined as ≤3 metastatic lesions which are progressing or new whilst all other sites of disease are well-controlled by ART. Methods: Retrospective analysis of electronic patient records and imaging studies of 95 patients treated with ART for mCRPC between April 2015 – 2017 from a single centre was undertaken. Data was analysed at the time of first tumour progression on ART. Results: The median (IQR) age of patients was 78.8 (74.4-83.6) years. OPD was found in 27 (28%) patients, 18 (19%) had lesions suitable for SBRT (Table). Seventeen (63%) patients were treated with abiraterone, 10 (27%) patients with enzalutamide. Median (IQR) time from starting ART to OPD was 16.4 (8.6-19.9) months. Five (19%) patients had 3 sites of OPD, 8 (29%) patients had 2 sites of OPD and 14 (52%) patients had 1 site of OPD. Nineteen patients continued ART beyond OPD for ≥3months. OPD was diagnosed using CT scan (56%), whole body diffusion-weighted MRI (22%), choline PET/CT (19%) and bone scan (3%). Six (22%) patients were treated with radiotherapy for OPD, 3 as participants of the TRAP trial (NCT03644303). Median time to subsequent progression after OPD for the 3 patients treated off trial with radiotherapy was 20.5 months. The OPD lesions treated with radiotherapy included the prostate (2 patients, 30 Gy in 5 and 24 Gy in 4 fractions) and para-aortic lymph node (1 patient, 30 Gy in 5 fractions). Median time to subsequent progression after OPD for those who did not receive radiotherapy was 6.4 months. There was no significant difference between median overall survival between patients with OPD and those who progressed with > 3 lesions (7 vs 9.2 years, P= 0.54). Ten (66%) patients who progressed after initial OPD on continuation of ART progressed with further OPD (≤3 lesions including original OPD lesion). Conclusions: OPD is prevalent in patients on ART for mCRPC. The most frequent site of OPD was in bone and majority of patients had only 1 site of OPD at presentation. These results identify a cohort of patients who may benefit from SBRT to maximise ART treatment. Fourteen (14%) patients met entry criteria for TRAP trial which is currently testing the role of SBRT to sites of OPD in mCRPC. [Table: see text]

scholarly journals Elevation of c-FLIP in Castrate-Resistant Prostate Cancer Antagonizes Therapeutic Response to Androgen Receptor–Targeted Therapy

2012 ◽  
Vol 18 (14) ◽  
pp. 3822-3833 ◽  
Author(s):  
Clare McCourt ◽  
Pamela Maxwell ◽  
Roberta Mazzucchelli ◽  
Rodolfo Montironi ◽  
Marina Scarpelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Targeted Therapy ◽  
Therapeutic Response ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

Treatment, healthcare resource utilization, and costs associated with non-metastatic and metastatic castration-resistant prostate cancer: A claims analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18341-e18341 ◽  
Author(s):  
Adriana Valderrama ◽  
Krishna Tangirala ◽  
Svetlana Babajanyan ◽  
Sreevalsa Appukkuttan ◽  
Lonnie Kent Wen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Management Strategies ◽  
Baseline Period ◽  
Healthcare Resource Utilization ◽  
Castration Resistant Prostate Cancer ◽  
Before And After ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

e18341 Background: Limited evidence exists about economic burden in non-metastatic castrate resistant prostate cancer (nmCRPC). The aim of this study was to describe the real-world treatments in this setting and to quantify both the costs and healthcare resource utilization (HCRU) during the year before and after metastasis for this patient population. Methods: A retrospective cohort of metastatic castrate resistant prostate cancer (mCRPC) patients was identified from Truven Health MarketScan database from January 2009 to March 2015 with metastasis diagnosis as index date. mCRPC algorithm was based on ICD-9 codes for both prostate cancer and secondary metastatic disease, and a subsequent claim for a FDA approved treatment for mCRPC. Patients were also required to have evidence of surgical or medical castration in the baseline period to define nmCRPC. Costs and HCRU were compared in the 1 year pre- and post-index time periods. Results: Among 341 mCRPC patients identified, mean age was 71.9 years (72.4% ≥65 years old), 72.7% were Medicare Advantage patients and 19.4% had Klabunde comorbidity > 1. Most common treatments in the pre index period were bicalutamide (90%), leuprolide (83.6%), docetaxel (27.6%), abiraterone (22.9%) and ketoconazole (21.4%). Mean per patient per year (PPPY) all cause HCRU and costs were significantly higher (all P < 0.05) in the mCRPC patients compared to nmCRPC patients (Table). Conclusions: Average yearly costs more than doubled following mCRPC diagnosis, which indicates the need for appropriate management strategies for nmCRPC patients in order to optimize the potential delay of disease progression. [Table: see text]

Evaluating the impact of bone-targeted agents in the era of novel androgen targeted therapy for metastatic castration-resistant prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16500-e16500
Author(s):  
Haoran Li ◽  
Dalia Kamel ◽  
Ricardo Fernandes ◽  
Dominick Bosse ◽  
Dong Vo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Targeted Therapy ◽  
Bone Metastases ◽  
Real World ◽  
Smoking History ◽  
Castration Resistant Prostate Cancer ◽  
Psa Response ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant ◽  
The Impact

e16500 Background: Patients with metastatic castrate resistant prostate cancer (mCRPC) often develop bone metastases, resulting in a risk of symptomatic skeletal events (SSE). Bone-targeted agent (BTA) has been integrated into the overall treatment strategy, but its role in the era of novel androgen-targeted therapy (ATT) is still unclear. Methods: A retrospective analysis of real-world practice from 2010 to 2015 was conducted. Patients diagnosed with mCRPC and bone metastases who received systemic therapy (docetaxel/abiraterone/enzalutamide) with or without BTA (zoledronic acid/denosumab/alendronate) were included. Results: We obtained data from 299 patients with a median follow-up of 75.5 months. Compared with no BTA, concomitant BTA was associated with decreased incident of SSE (3.8% vs. 19.2%, p< 0.001), especially in the need for bone radiation (1.9% vs. 15.8%, p< 0.001). Compared to patients without SSE, patients with SSE were more likely to have previous fracture history (10.8% vs. 9.7%, p= 0.047), steroid use history (2.4% vs. 1.4%, p= 0.019), smoking history (53.0% vs. 38.9%, p= 0.009), diabetes (19.3% vs. 8.8%, p= 0.012) and reduced baseline mobility (9.6% vs. 4.2%, p= 0.002). Among those who received first-line novel ATT (n = 152), concurrent ATT+BTA significantly decreased the incident of SSE (2.8% vs. 27.3%, p= 0.004) and prolonged the time to SSE (24.3 vs. 3.2 mo, p< 0.001), when compared to ATT alone. But there was no difference in overall survival between two groups (134.2 vs. 138.9 mo, p= 0.99). In patients who responded to systemic treatment with PSA declining, the SSE rate (2.4% vs. 14.3%, p= 0.037) was lower and the time to SSE was longer (49.6 vs. 32.3 mo, p= 0.026) than those who did not respond. Smoking history (adjusted HR = 1.46, p= 0.013) and PSA response (adjusted HR = 0.19, p< 0.001) are independent risk factors for SSE. Conclusions: This real-world database suggests that concomitant BTA with novel ATT was associated with reducing SSEs. PSA decrease might be used as a predictive factor for those under BTA treatment. Further studies are warranted to validate the role of PSA response.

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