Time trends in systemic treatment for patients with metastatic prostate cancer: a national cohort study

Several new systemic treatments for primary metastatic prostate cancer patients (mPCa) were introduced in the last decade for both hormone-sensitive (mHSPC) and castration-resistant prostate cancer (mCRPC). However, little is known about the introduction of these treatments in clinical practice. In this national cohort study, we described users and non-users of systemic treatment beyond androgen deprivation therapy (ADT). We also explored whether there was a shift in treatment patterns after the introduction of Docetaxel for mHSPC patients. All patients registered in the Cancer Registry of Norway with mPCa diagnosed in 2010-18 were included. Data on systemic therapy (Docetaxel, Abiraterone, Enzalutamide, Cabazitaxel, and Radium-223) were provided from the Norwegian Prescription Database, the Norwegian Patient Registry, and the Norwegian Control and Payment of Health Reimbursement Database. Descriptive results about patient and disease characteristics were presented using frequencies and proportions, means and standard deviations, or medians and interquartile ranges. Of the 2770 patients included in this study, 48% received systemic treatment beyond ADT. The proportion of patients receiving systemic treatment increased during the study period. Systemic treatment users were younger, in better general condition, and had more aggressive tumors than non-users. A treatment shift was observed after 2015, with 48% of patients receiving systemic treatment (mainly Docetaxel) in the mHSPC phase compared to 4% of those diagnosed 2010-14. No significant treatment differences were observed across health regions. An increasing proportion of patients received systemic treatment during the period 2010–18. However, less than 50% of patients in our study received systemic treatment. In accordance with updated guidelines, Docetaxel was introduced after 2015 with an increasing proportion of patients receiving systemic treatment as mHSPC. Further studies should address the disease course and treatment given to patients who do not receive systemic treatment.

近十年来，针对激素敏感性转移性前列腺癌（hormone-sensitive metastatic prostate cancer, mHSPC）与去势抵抗性转移性前列腺癌（castration-resistant metastatic prostate cancer, mCRPC）患者，多款针对原发性转移性前列腺癌（primary metastatic prostate cancer, mPCa）的新型系统性治疗方案相继问世。不过，目前学界对这类治疗方案在临床实践中的落地应用情况仍知之甚少。本项全国性队列研究对雄激素剥夺治疗（androgen deprivation therapy, ADT）之外的系统性治疗的使用者与非使用者进行了描述性分析，并探讨了多西他赛（Docetaxel）获批用于mHSPC患者治疗后，临床治疗模式是否发生了转变。本研究纳入了2010至2018年期间在挪威癌症登记处完成备案的所有确诊mPCa患者。本研究所需的系统性治疗相关数据（涵盖多西他赛（Docetaxel）、阿比特龙（Abiraterone）、恩扎卢胺（Enzalutamide）、卡巴他赛（Cabazitaxel）与镭-223（Radium-223））来源于挪威处方数据库、挪威患者登记库以及挪威健康报销管控与支付数据库。本研究通过频数与构成比、均值与标准差，或中位数与四分位间距，呈现患者基线特征与疾病特征的描述性分析结果。本研究共纳入2770例患者，其中48%的患者接受了ADT之外的系统性治疗。研究期间，接受系统性治疗的患者占比呈逐年上升趋势。与未接受系统性治疗的患者相比，接受治疗的患者年龄更轻、整体健康状况更佳，且肿瘤侵袭性更强。2015年后临床治疗模式出现显著转变：2010至2014年确诊的患者中仅4%在mHSPC阶段接受系统性治疗（以多西他赛为主），而2015年后该比例升至48%。不同卫生区域间未观察到显著的治疗方案差异。2010至2018年期间，接受系统性治疗的患者占比持续升高，但本研究中仍仅有不足50%的患者接受了系统性治疗。本研究结果符合最新临床指南推荐：2015年后多西他赛正式应用于临床，且mHSPC患者接受系统性治疗的占比逐年攀升。未来的研究应聚焦于未接受系统性治疗的患者的疾病病程与临床治疗方案选择。