Treatment trends in patients with de novo metastatic prostate cancer in the era of upfront combination therapy.

Autor: Miura H; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Hatakeyama S; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Tabata R; Department of Urology, Ageo Central General Hospital, Ageo, Japan., Fujimori D; Department of Urology, Ageo Central General Hospital, Ageo, Japan., Kawashima Y; Department of Urology, Ageo Central General Hospital, Ageo, Japan., Moriyama S; Department of Urology, Ageo Central General Hospital, Ageo, Japan., Oishi T; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Horiguchi H; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Soma O; Department of Urology, Odate Municipal Hospital, Odate, Japan., Noro D; Department of Urology, Mutsu General Hospital, Mutsu, Japan., Tanaka T; Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan., Okamoto T; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Yamamoto H; Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan., Sato S; Department of Urology, Odate Municipal Hospital, Odate, Japan., Ohyama C; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan.
Jazyk: angličtina
Zdroj: International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2024 Aug 23. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1111/iju.15550
Abstrakt: Objectives: The objective of this study is to assess the trends in treatment selection for patients with de novo metastatic castration-sensitive prostate cancer in the era of upfront combination therapy.
Methods: This multicenter retrospective study included 595 patients treated with either upfront combination therapy (upfront novel hormonal therapies and taxane-based chemotherapy) or vintage therapy (androgen deprivation therapy with or without bicalutamide) between 2016 and 2021. High tumor burden metastatic disease was defined when a patient met the CHAARTED or LATITUDE criteria. We evaluated trends in treatment selection and reasons for selecting vintage therapy.
Results: Of the 595, 123 and 472 patients were classified as having low and high tumor-burden disease, respectively. The Use of upfront combination therapy was found to be rapidly increasing with utilization rates of 72% and 54% in 2021 for high and low tumor-burden disease, respectively. Multivariable logistic regression analysis found older age, poor performance status, and nonacademic center were significantly associated with the selection of vintage therapy. Of the 163 patients who received vintage hormone therapy after approval of upfront therapy, 74.2% had a specific reason for avoiding upfront therapy. The reasons for selecting vintage therapy included refusal (39.8%), older age (67.6%), frailty (56.3%), and comorbidity (40.8%). Furthermore, 16.9% of patients declined upfront combination therapy due to cost concerns.
Conclusion: Upfront combination therapy use has 72% and 54% prevalence among patients with high and low tumor burden diseases, respectively, in this current practice. Older age, poor performance status, and facility bias were negatively associated with the use of upfront combination therapy.
(© 2024 The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)
Databáze: MEDLINE
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