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Title: Real-world first-line systemic therapy patterns in metastatic castration-resistant prostate cancer.
Austin Authors: Anton, Angelyn;Pillai, Sruti;Semira, Marie Christine;Wong, Shirley;Shapiro, Julia;Weickhardt, Andrew J ;Azad, Arun;Kwan, Edmond M;Spain, Lavinia;Gunjur, Ashray ;Torres, Javier;Parente, Phillip;Parnis, Francis;Goh, Jeffrey;Baenziger, Olivia;Gibbs, Peter;Tran, Ben
Affiliation: Alfred Health Melbourne, Victoria, Australia..
Department of Medical Oncology Western Health, Melbourne, Victoria, Australia..
Department of Medical Oncology Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia..
Department of Medical Oncology Goulburn Valley Health, Shepparton, Victoria, Australia..
Department of Medical Oncology Monash Health, Melbourne, Victoria, Australia..
Olivia Newton-John Cancer Wellness and Research Centre
Department of Medical Oncology Eastern Health, Melbourne, Victoria, Australia..
Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne, Victoria, Australia..
Department of Medical Oncology Adelaide Cancer Centre, Adelaide, South Australia, Australia..
Faculty of Health and Medical Sciences University of Adelaide, Adelaide, South Australia..
Department of Medical Oncology Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia..
Division of Personalised Medicine Walter and Eliza Hall Institute, Melbourne, Victoria, Australia..
Issue Date: 14-Dec-2021
Date: 2022-05
Publication information: BJUI Compass 2022; 3(3): 205-213
Abstract: Several systemic therapies have demonstrated a survival advantage in metastatic castration resistant prostate cancer (mCRPC). Access to these medications varies significantly worldwide. In Australia until recently, patients must have received docetaxel first, unless unsuitable for chemotherapy, despite no evidence suggesting superiority over androgen receptor signalling inhibitors (ARSIs). Our study investigated real-world systemic treatment patterns in Australian patients with mCRPC. The electronic CRPC Australian Database (ePAD) was interrogated to identify mCRPC patients. Clinicopathological features, treatment and outcome data, stratified by first-line systemic therapies, were extracted. Comparisons between groups utilised Kruskal-Wallis tests and Chi-Square analyses. Time-to-event data were calculated using Kaplan-Meier methods and groups compared using log-rank tests. Factors influencing overall survival (OS) and time to treatment failure (TTF) were analysed through Cox proportional hazards regression models. We identified 578 patients who received first-line systemic therapy for mCRPC. Enzalutamide (ENZ) was most commonly prescribed (n = 240, 41%), followed by docetaxel (DOC, n = 164, 28%) and abiraterone (AA, n = 100, 17%). Patients receiving ENZ or AA were older (79, 78.5 years respectively) compared with DOC (71 years, p = 0.001) and less likely to have ECOG performance status 0 (45%, 44%, 59% in ENZ, AA and DOC groups respectively p < 0.0001). Median TTF was significantly higher in those receiving ENZ (12.4 months) and AA (11.9 months) compared to DOC (8.3 months, p < 0.001). PSA50 response rates and OS were not statistically different. Time to developing CRPC > 12 months was independently associated with longer TTF (HR 0.67, p < 0.001) and OS (HR 0.49, p = 0.002). In our real-world population, ENZ and AA were common first-line systemic therapy choices, particularly among older patients and those with poorer performance status. Patients receiving ENZ and AA demonstrated superior TTF compared to DOC, while OS was not statistically different. Our findings highlight the important role of ARSIs, given the variability of access worldwide.
DOI: 10.1002/bco2.129
Journal: BJUI Compass
PubMed URL: 35492221
PubMed URL:
Type: Journal Article
Subjects: abiraterone
metastatic castration‐resistant prostate cancer
real‐world data
systemic therapy
Appears in Collections:Journal articles

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