Treatment Patterns and Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer in a Real-world Clinical Practice Setting in the United States
Treatment Patterns and Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer in a Real-world Clinical Practice Setting in the United States
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DOI：
10.1016/j.clgc.2019.12.019
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发表时间：
2020-08-01
影响因子：
3.2
通讯作者：
Higano, Celestia S.
中科院分区：
文献类型：
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作者：
George, Daniel J.;Sartor, Oliver;Higano, Celestia S.
关于晚期前列腺癌的实际治疗信息有限。我们使用了来自2500多名转移性去势抵抗性前列腺癌患者的电子病历数据库，以确定真实世界的治疗模式，并展示指南依从性的改进领域，以帮助医疗保健专业人员做出如何最好地治疗前列腺癌以改善结局的决定。背景：临床试验已经证明了几种延长生命的疗法对转移性去势抵抗性前列腺癌（mCRPC）的疗效;然而，关于其使用、生存效果和安全性真实世界数据是有限的。使用Flatiron Health数据库的电子健康记录数据，我们研究了mCRPC患者的真实治疗模式和健康结局。患者和方法：我们对2013年1月至2017年9月期间确诊mCRPC患者的电子健康记录数据进行了一项回顾性、非干预性队列分析。主要目的是描述真实世界的治疗模式，包括治疗类型、持续时间和顺序。次要目的包括描述患者特征和临床结局。结果如下：在2559例mCRPC患者中，1980例（77%）接受了至少一线延长生命治疗（阿比特龙、enzalutamide、多西他赛、卡巴他赛、sipuleucel-T或镭-223）。在接受一线治疗的患者中，49%接受二线治疗，其中43%接受三线治疗。阿比特龙/泼尼松和Enzalutamide占一线治疗的65%，占二线治疗的54%。多西他赛是最常见的三线治疗（24%）。阿比特龙/泼尼松和enzalutamide的背靠背使用很常见。镭-223单药治疗在一线治疗中占2%，二线治疗中占3%，三线治疗中占8%。接受延长生命治疗的患者的中位总生存期（23.7个月; 95%置信区间：22.3-25.1个月）长于未接受延长生命治疗的患者（10.1个月; 95%置信区间：9.1-11.5个月）。结论：这些对2500多例mCRPC患者的真实见解补充了随机对照试验的结果，可能有助于为临床试验设计、治疗指南和临床决策提供信息。(C)2020年，任作家。爱思唯尔公司出版
Information on real-world treatment of advanced prostate cancer is limited. We used a database of electronic medical records from over 2500 patients with metastatic castration-resistant prostate cancer to identify real-world treatment patterns and demonstrate areas for improvement in guideline adherence to help health care professionals make decisions on how best to treat prostate cancer to improve outcomes.Background: Clinical trials have demonstrated the efficacy of several life-prolonging therapies for metastatic castration-resistant prostate cancer (mCRPC); however, real-world data on their use, survival effect, and safety are limited. Using electronic health record data from the Flatiron Health database, we studied real-world treatment patterns and health outcomes in patients with mCRPC. Patients and Methods: We conducted a retrospective, noninterventional cohort analysis of electronic health record data of patients with confirmed mCRPC between January 2013 and September 2017. The primary objective was to describe real-world treatment patterns, including treatment type, duration, and sequencing. Secondary objectives included describing patient characteristics and clinical outcomes. Results: Of 2559 patients with mCRPC, 1980 (77%) received at least 1 line of life-prolonging therapy (abiraterone, enzalutamide, docetaxel, cabazitaxel, sipuleucel-T, or radium-223). Of patients receiving first-line therapy, 49% received second-line therapy, and of these, 43% received third-line therapy. Abiraterone/prednisone and enzalutamide accounted for 65% of first-line therapies and 54% of second-line therapies. Docetaxel was the most common third-line therapy (24%). Back-to-back use of abiraterone/prednisone and enzalutamide was common. Radium-223 monotherapy use was 2% in the first-line setting, 3% in the second-line setting, and 8% in the third-line setting. The median overall survival was longer in patients who received life-prolonging therapies (23.7 months; 95% confidence interval: 22.3-25.1 months) than in those who did not (10.1 months; 95% confidence interval: 9.1-11.5 months). Conclusion: These real-world insights on over 2500 patients with mCRPC supplement findings from randomized controlled trials and may help to inform clinical trial design, treatment guidelines, and clinical decision-making. (C) 2020 The Authors. Published by Elsevier Inc.