Treatment patterns and survival by race among men with metastatic castration-resistant prostate cancer (mCRPC) in the United States: A US electronic medical record database 2020-2023.

Abstract

e17058 Background: Given the potential shift of androgen receptor pathways (ARPI)/docetaxel use to earlier disease states of metastatic hormone-sensitive PC (mHSPC), very little is known regarding the impact of these changes on the management and survival in the later state of mCRPC, especially within racial minorities. Therefore, we examine treatment utilization and survival outcomes by race among patients with mCRPC within the United States (US). Methods: A retrospective cohort of patients treated for mCRPC between 2020-2023 was identified in the ConcertAI NLP360 oncology electronic medical records (EMR) database, which includes data from 900+ US oncology centers. Evidence of CRPC and being previously diagnosed with mHSPC was confirmed through a clinical algorithm. Continuous EMR activity for ≥12 months pre-mCRPC and ≥6 months post-mCRPC was required to capture baseline characteristics and outcomes. Line of therapy was identified as ARPI, chemotherapy, poly (ADP-ribose) polymerase inhibitors (PARPIs), immunotherapy (pembrolizumab, sipuleucel-T), radiopharmaceuticals (Ra-223, 177 Lu-PSMA-RLT), alone or in combination. Results: Of609 patients, 456 (75%), 88 (14%), and 65 (11%) were White, African-American (AA), and other races, respectively. Median age was 72 years (interquartile range: 66-79). Nearly 85% had ECOG 0-1, 79% had bone metastases, and 42% received bone-health agents during baseline. Most received ADT alone for mHSPC (53%), followed by ADT+ARPI (37%) and ADT+Docetaxel (10%). Except for a higher use of bone-health agents at baseline in Whites (43% vs. 31%), there were no significant differences in baseline clinical and treatment characteristics by race. Overall, ARPI (62%) [abiraterone: 25%; enzalutamide: 24%; apalutamide: 9%; darolutamide 4%] and chemotherapy (22%) [docetaxel 16%; cabazitaxel 6%] were most common first-line treatment (1L Tx) for mCRPC. This trend was consistent by race except for a marginal higher use of ARPI and lower use of chemotherapy among AAs and vs. Whites (Table). Median real-world overall survival (rwOS) from 1L mCRPC Tx was 21 months (95% confidence interval: 18, 25) with no significant difference across the race groups. Conclusions: ARPI and chemotherapy remained the most utilized therapies in mCRPC from 2020 to 2023 in the US. Treatment and survival outcomes did not differ significantly between Whites and AAs in mCRPC. Treatment and survival by race in mCRPC. Study Outcomes Overall, %(n=609) Race, % Whites(n=456) AA (n=88) Others (n=65) 1L mCRPC Treatment, % ARPI 62 63 69 46 Chemotherapy 22 21 17 37 Immunotherapy 5 5 5 5 Radiopharmaceuticals 3 3 1 9 PARPi 2 2 3 2 Combination Therapy 6 5 2 6 Survival, 95% CI Median Time to rwOS1-Year OS rate2-Year OS rate 21 (18-25)67 (63-71)46 (41-51) 22 (18-27)67 (62-72)46 (41-52) 17 (15-28)69 (59-81)46 (28-56) 16 (13-NE)62 (50-76)46 (33-64) NE, not evaluable.