H M Westgeest1,2, M C P Kuppen3, A J M van den Eertwegh4, R de Wit5, A M Bergman6, R J A van Moorselaar7, J L L M Coenen8, A C M van den Bergh9, D M Somford10, N Mehra11, I M van Oort12, K K H Aben13, W R Gerritsen11, C A Uyl-de Groot3. 1. Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands. hwestgeest@amphia.nl. 2. Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands. hwestgeest@amphia.nl. 3. Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands. 4. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands. 5. Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, the Netherlands. 6. Division of Internal Medicine (MOD) and Oncogenomics, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. 7. Department of Urology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands. 8. Department of Internal Medicine, Isala Klinieken, Zwolle, the Netherlands. 9. Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands. 10. Department of Urology, Canisius Wilhemina Hospital, Nijmegen, the Netherlands. 11. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands. 12. Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands. 13. Department for Health Evidence, Radboud University Medical Center, The Netherlands and Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Abstract
BACKGROUND: In 2004 docetaxel was the first life-prolonging drug (LPD) registered for metastatic castration-resistant prostate cancer (mCRPC) patients. Between 2011 and 2014 new LPDs for mCRPC (cabazitaxel, abiraterone, enzalutamide, and radium-223) were introduced in the Netherlands. The objective of this study is to assess the impact of the introduction of new LPDs on treatment patterns and overall survival (OS) over time. PATIENTS AND METHODS: CRPC patients diagnosed in the years 2010-2016 in the observational, retrospective CAPRI registry (20 hospitals) were included and followed up to 2018. Two subgroups were analyzed: treatment-naïve patients (subgroup 1, n = 3600) and post-docetaxel patients (subgroup 2, n = 1355). RESULTS: In both subgroups, the use of any LPD increased: from 57% (2010-2011) to 69% (2014-2015) in subgroup 1 and from 65% (2011-2012) to 79% (2015-2016) in subgroup 2. Chemotherapy as first mCRPC-treatment (i.e., docetaxel) and first post-docetaxel treatment (i.e., cabazitaxel or docetaxel rechallenge) decreased (46-29% and 20-9% in subgroup 1 and 2, respectively), while the use of androgen-receptor targeting treatments (ART) increased from 11% to 39% and 46% to 64% in subgroup 1 and 2, respectively. In subgroup 1, median OS (mOS) from diagnosis CRPC increased from 28.5 months to 31.0 months (p = 0.196). In subgroup 2, mOS from progression on docetaxel increased from 7.9 months to 12.5 months (p < 0.001). After multiple imputations of missing values, in multivariable cox-regression analysis with known prognostic parameters, the treatment period was independent significant for OS in subgroup 1 (2014-2015 vs. 2010-2011 with HR 0.749, p < 0.001) and subgroup 2 (2015-2016 vs. 2011-2012 with HR 0.811, p = 0.037). CONCLUSION: Since 2010, a larger proportion of mCRPC patients was treated with LPDs, which was related to an increased mOS.
BACKGROUND: In 2004 docetaxel was the first life-prolonging drug (LPD) registered for metastatic castration-resistant prostate cancer (mCRPC) patients. Between 2011 and 2014 new LPDs for mCRPC (cabazitaxel, abiraterone, enzalutamide, and radium-223) were introduced in the Netherlands. The objective of this study is to assess the impact of the introduction of new LPDs on treatment patterns and overall survival (OS) over time. PATIENTS AND METHODS: CRPC patients diagnosed in the years 2010-2016 in the observational, retrospective CAPRI registry (20 hospitals) were included and followed up to 2018. Two subgroups were analyzed: treatment-naïve patients (subgroup 1, n = 3600) and post-docetaxel patients (subgroup 2, n = 1355). RESULTS: In both subgroups, the use of any LPD increased: from 57% (2010-2011) to 69% (2014-2015) in subgroup 1 and from 65% (2011-2012) to 79% (2015-2016) in subgroup 2. Chemotherapy as first mCRPC-treatment (i.e., docetaxel) and first post-docetaxel treatment (i.e., cabazitaxel or docetaxel rechallenge) decreased (46-29% and 20-9% in subgroup 1 and 2, respectively), while the use of androgen-receptor targeting treatments (ART) increased from 11% to 39% and 46% to 64% in subgroup 1 and 2, respectively. In subgroup 1, median OS (mOS) from diagnosis CRPC increased from 28.5 months to 31.0 months (p = 0.196). In subgroup 2, mOS from progression on docetaxel increased from 7.9 months to 12.5 months (p < 0.001). After multiple imputations of missing values, in multivariable cox-regression analysis with known prognostic parameters, the treatment period was independent significant for OS in subgroup 1 (2014-2015 vs. 2010-2011 with HR 0.749, p < 0.001) and subgroup 2 (2015-2016 vs. 2011-2012 with HR 0.811, p = 0.037). CONCLUSION: Since 2010, a larger proportion of mCRPC patients was treated with LPDs, which was related to an increased mOS.
Authors: Sabine Siesling; Otto Visser; Mieke J Aarts; Rob H A Verhoeven; Katja K H Aben; Avinash G Dinmohamed; Boukje van Dijk; Maaike van der Aa; Marieke Louwman; Valery E P P Lemmens Journal: Ned Tijdschr Geneeskd Date: 2019-06-17