Real-world treatment patterns, sequences, and outcomes in patients with mCRPC in US urology clinics.

Abstract

e17069 Background: Managing community-based patients with mCRPC is challenging due to varied treatment and sequencing strategies, which impact clinical outcomes. Methods: We retrospectively reviewed patients with a diagnosis of mCRPC aged 21 years or older, who were seen in community urology practices in the United States between July 1, 2019, and March 31, 2024. Baseline demographics, treatment patterns and sequencing and clinical outcomes including overall survival (OS) from the initiation of 1L therapy, were assessed. Results: The cohort included 5,432 patients; 58.7% were White, 14.2% African American, 0.9% Asian, and 26.2% other/unknown. At mCRPC diagnosis, the mean age was 75 years (SD 9.06), median Gleason score was 8.0 (IQR 2.0), and median PSA was 2.64 ng/mL (IQR 10.41). All treatments received pre-mCRPC (prostate cancer stage immediately prior to mCRPC diagnosis) and mCRPC therapy are shown in the Table. Of all patients treated pre-mCRPC, ADT alone was the most common pre-mCRPC treatment (3,479, 77.9%) and of mHSPC patients (N=2,684), ADT alone was the most common 1L mHSPC treatment (73.0%). Of the 1,914 patients treated with androgen receptor pathway inhibitors (ARPIs) pre-mCRPC, including enzalutamide (enza), abiraterone (abi), apalutamide, and darolutamide, 95.8%, were treated with ARPI ± ADT. The most common treatment sequence from pre-mCRPC to 1L mCRPC was ADT alone to enza (N=840, 33.1%). Of all patients, 38.9% received 2L and 11.1% received 3L mCRPC therapy. For patients who did not receive more than 2L therapy (N = 1,514), the most common 1L to 2L sequence was sipuleucel-T to enza (N=183, 12.0%), The most common treatment sequence 2L to 3L (N=438) was enza to abi (N=24, 5.5%). Median OS for all patients from mCRPC diagnosis was 45.6 months (CI: 42.58, 47.21) with shorter OS observed after 1L (40.3 months [CI: 38.4, 42.9]), 2L (31.1 months [CI: 28.9, 34.1]) and 3L (20.5 months [CI: 17.6, 23.8]) treatment. Conclusions: This data indicates the majority of patients used ADT alone pre-mCRPC. ARPI rechallenge was the most common treatment sequence from pre-mCRPC to mCRPC among ARPI exposed patients. Less than half of the patients analyzed received 2L+ therapy. With increasing lines of treatment, OS decreased. Treatment patterns among patients with mCRPC by disease state and line of therapy. Treatment Characteristic Pre-mCRPC (N = 4465) mCRPC 1L (N = 5432) mCRPC 2L (N = 2117) mCRPC 3L (N = 603) Prior ARPI treated,N (%) 1914 (42.9) 4122 (75.9) 1799 (85.0) 463 (76.8) ARPI naïve,N (%) 3551 (57.1) 1310 (24.1) 318 (15.0) 140 (23.2) ADT alone,N (%) 3479 (77.9) — — — ARPI (± ADT),N (%) 1834 (41.1) 3312 (61.0) 1016 (48.0) 240 (39.8) Chemotherapy ± ADT,N (%) 65 (1.5) 92 (1.7) 98 (4.6) 32 (5.3) ADT + ARPI + Chemotherapy, N (%) 17 (0.4) — — — Other*,N (%) 257 (5.8) 2028 (37.3) 1003 (47.4) 331 (54.9) *Other includes regimens with sipuleucel-T, olaparib, and ADT+ARPI+sipuleucel-T.