Methods
A retrospective cohort of men treated for mCRPC between 2020-2023 was identified in the ConcertAI NLP360 oncology electronic medical records (EMR) database in the United States. Men with mCRPC were identified based on their first record for castration resistance after an earlier diagnosis of mHSPC. Men were required to have continuous EMR activity ≥12 months pre-mCRPC (baseline) and ≥6 months post-mCRPC. Line of therapy was identified as ABI, non-ABI ARPI, taxane-based chemotherapy, poly (ADP-ribose) polymerase inhibitors (PARPIs), immunotherapy (pembrolizumab, sipuleucel-T), radiopharmaceuticals (Ra-223, 177Lu-PSMA-RLT), alone or in combination.
Results
The cohort comprised 609 men with mCRPC who had progressed from mHSPC. Median age was 72 years (interquartile range: 66-79). Nearly 85% had ECOG 0-1, 79% had bone metastases, and 42% received bone-health agents during baseline. Most men had received ADT alone for mHSPC (53%), followed by ADT+ABI (19%), ADT+non-ABI ARPI (18%), and ADT+Docetaxel (10%). Overall, the most common first line treatment (1L Tx) for mCRPC was ARPI (62%; enzalutamide [28%] and ABI [25%]) and chemotherapy (22%). This trend was consistent in men with prior ADT for mHSPC. Among those who had received ADT+ARPI for mHSPC, sequentially ARPI as 1L Tx was common (most common on ADT+ABI and 2nd most common among ADT+non-ABI ARPI). 1L chemotherapy use was more common among men with ADT+ARPI/DOC for mHSPC, compared to ADT alone (see Table 1), though was still less than 50% in the ADT+non-ABI ARPI group. Median real-world overall survival from 1L Tx was 21 months (95% confidence interval: 18, 2
Conclusions
With more than half of patients having received ADT alone in mHSPC, use of ARPIs was the most common 1L Tx option in mCRPC. Back-to-back use of ARPI upon progression to mCRPC was common. These findings highlight the need to explore alternative treatment option in mCRPC beyond ARPIs to improve survival in men with mCRPC.
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