Insights into Treatment Patterns in the Routine Care of Patients Diagnosed with Metastatic Castration-Resistant Prostate Cancer in Germany After the Introduction of New Therapies
2020
Background: Clinical treatment guidelines for metastatic castration-resistant prostate cancer (mCRPC)
predominantly rely on the evidence from clinical trials, which frequently apply restrictive eligibility criteria
resulting in selected patient populations. Therefore, real world treatment pattern may deviate from
recommendations. We aimed to describe treatment patterns including sequencing and treatment duration of
patients diagnosed with mCRPC in Germany, by characterizing the demographic and clinical characteristics
of patients.
Methods: A large German claims database was used to identify males who were diagnosed and treated for
mCRPC (ICD-10-GM code C61) between January 2013 and December 2015. Patients were required to be
continuously enrolled 12 months before initiation of treatment with abiraterone, cabazitaxel, docetaxel, or
enzalutamide. Study endpoints included lines of therapy, treatment duration and treatment sequencing.
Treatment duration was calculated via Kaplan-Meier estimates.
Results: There were n=447 patients meeting all inclusion criteria in the database. Mean age (±SD) was 72.9
(±8.8) years, mean Charlson comorbidity index was 8.1, there were on average 1.9 hospitalizations within
the 12 months before the index, and 70% of patients presented with bone metastasis. Overall, abiraterone
was the most commonly prescribed treatment across lines of therapy while cabazitaxel, was the least utilized
therapy. The longest treatment duration was seen in abiraterone patients (median duration of 8.3 months in
first and 7.4 months in second line). Switches between abiraterone and docetaxel in first and second line
were common. Among the 447 patients more than 70 different pathways were identified.
Conclusion: There was a significant variability in treatment pathways pointing to a highly individualized
treatment approach in spite of detailed treatment algorithms. Even in third line, systemic therapies were still
being prescribed. Furthermore, this study showed that routine-care data are a valuable source to assess the
actual treatment pathways on a cohort but also on an individual level.
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