Changes in therapeutic strategy in metastatic castration ... · 2012 2014 12% 21% 18% 18% 87% 77%...
Transcript of Changes in therapeutic strategy in metastatic castration ... · 2012 2014 12% 21% 18% 18% 87% 77%...
2012 2014
12%
21%18% 18%
87%
77%81% 80%
NDx mHSPC Progressive mHSPC nmCRPC nmHSPC
Abiraterone acetate Docetaxel
48%
61%
72%
62%
46%
30%
21%
30%
4% 6% 4% 4%
NDx mHSPC Progressive mHSPC nmCRPC nmHSPC
Abiraterone acetate Docetaxel Enzalutamide
Legend Legend
80.9%Doce.
17.5%Abi.
Doce.30.7%
61.9%
Abi.
4.5%Enza.
1 Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France – 2 CHU de Bordeaux, Bordeaux, France – 3 Clinique Beau Soleil, Montpellier, France 4 CHU de Toulouse, Toulouse, France – 5 ESSEC, Cergy-Pontoise, France – 6 Janssen, Issy les Moulineaux, France
Changes in therapeutic strategy in metastatic castration resistant prostate cancer (mCRPC) between 2012 and 2014 from the French nationwide claims database (SNDS)
• The arrival of new therapeutic strategies has impacted mCRPC management: 8 out of 10 patientsused docetaxel as 1st line in 2012 whereas they were only 3 out of 10 in 2014, most of the remainingpatients used abiraterone acetate (Table 1)
Nicolas Thurin1,2 *, Magali Rouyer1, Jérémy Jové1, Marine Gross-Goupil2, Thibaud Haaser2, Xavier Rébillard3, Michel Soulié4, Gérard de Pouvourville5, Camille Capone6, Marie Pierrès6, Stéphanie Lamarque1, Emmanuelle Bignon1, Cécile Droz-Perroteau1, Nicholas Moore1,2, Patrick Blin1
• To describe patients characteristics according to the 1st treatment lines in 2012 and 2014• To describe treatment lines for mCRPC patients in 2012 an 2014• To assess the therapeutic strategic changes for mCRPC between 2012 and 2014
35th Annual European Association of Urology CongressMarch 20-24, 2020, Amsterdam, The Netherlands
Poster#580
Declaration of interest statement: The CAMERRA study is carried out by the Bordeaux PharmacoEpi platform incollaboration with Janssen® company and supervised by a Scientific Committee
ØStudy design• Two cohorts of mCRPC patients identified using a validated algorithm and initiating a
mCRPC specific treatment with a 5-year history prior index date and a 3-year follow-up:- 2012 cohort: patients initiating a 1st treatment line for mCPRC in 2012- 2014 cohort: patients initiating a 1st treatment line for mCPRC in 2014
ØData source• SNDS: National Healthcare System database covering the overall French population from
birth (or immigration) to death (or emigration), including all reimbursed claims from allFrench healthcare insurance schemes (e.g. drugs, medical visits, medical visits, etc.),hospital-discharge summaries from French public and privates hospitals (e.g. diagnosticcodes, procedures, etc.) and the National death registry
• Selection of patients ≥ 40 years, affiliated to the “Régime Général” insurance scheme(86% of French population) and having a complete healthcare historic
ØSetting• mCRPC 1st line treatments: abiraterone acetate, docetaxel or enzalutamide, all drugs
presumed to be used according to the Summary of Product Characteristics• Previous prostate cancer stages before mCRPC status defined according to the estimated
date of castration resistance and the estimated date of 1st metastasis management:- non-metastatic hormonosensitive prostate cancer (nmHSPC)- metastatic hormonosensitive prostate cancer newly diagnosed (NDx mHSPC)- progressive metastatic hormonosensitive prostate cancer (progressive mHSPC)- non-metastatic castration resistant prostate cancer (nmCRPC)
Materials & Methods
• Therapeutic strategy in metastatic castration-resistant prostate cancer (mCRPC) hasevolved significantly with the introduction of new 1st-line treatments since the end of 2012:- Abiraterone acetate in association with prednisone/prednisolone in December 2012- Enzalutamide in November 2014
Background
Conclusion
• The algorithm, with a positive predictive value of 0.92, enabled the identification of respectively11 668 prevalent mCRPC cases in 2012 and 12 951 in 2014. From them 2 921 patients initiated afirst treatment for mCRPC in 2012 and 3 949 in 2014
• mCRPC prevalence may be slightly underestimated because of the sensitivity of the algorithm (76%)
Results
Figure 1. Identification of population in 2012 and 2014 from SNDS database
Figure 4. Sequences of mCRPC treatment lines over the 3-year follow-up in 2012 and 2014 populations
2012 n = 2 921
2014 n = 3 949
Docetaxel 2 364 (80.9) 1 214 (30.7) Abiraterone acetate 511 (17.5) 2 444 (61.9) Enzalutamide 0 (0.0) 176 (4.5)
Treatment line = at least 2 consecutive dispensing or infusion during follow-up
Figure 2. Disease stage before mCRPC status in 2012 and 2014 CAMERRA populations
Table 1. First treatment line over the 3-year follow-up for 2012 and 2014 populations
• Over the 3-year follow-up, 63% of 2012 population and 58% of 2014 population received a2nd mCRPC treatment line (Figure 4):
- In 2012: the 2nd line was abiraterone acetate for 83% of the concerned patients- In 2014: the 2nd line were enzalutamide and docetaxel for respectively 41% and 31% of the
concerned patients
• In 2012:- Docetaxel mainly used- Few variations according to the stage before mCRPC status
• In 2014:- Abiraterone acetate mainly used in patients with previous stage of progressive mHSPC,
nmHSPC and nmCRPC stages- Abiraterone acetate and docetaxel equally used in patients in patients with previous stage of
NDx mHSPC
2012 2014
• Previous disease stages before mCRPC status barely changed between 2012 and 2014
Identification of 2012 and 2014 study population
Disease stage before mCRPC status
1st treatment line in mCRPC patients
1st treatment line according to disease stage before mCRPC status
Sequences of mCRPC treatment lines
2012 2014
47%nmHSPC
15%NDx mHSPC
18%Progressive
mHSPC
20%nmCRPC
52%nmHSPC
15%NDx mHSPC
15%Progressive
mHSPC
18%nmCRPC
Objectives
ü Between 2012 and 2014, the mCRPC 1st-line treatment shifted from docetaxelfor 4 out of 5 patients to abiraterone acetate for 3 out of 5
ü In 2014, docetaxel or enzalutamide were equally used in 2nd-line after abirateroneacetate
ü Disease stage before mCRPC seemed to have more impact in the treatmentchoice in 2014 than in 2012
Abiraterone acetate Docetaxel Enzalutamide Cabazitaxel Combinationtherapy
No mCRPC treatment Death
Figure 3. 1st treatment line according to disease stage before mCRPC status in 2012 and 2014
2012 2014
Abiraterone acetate Docetaxel EnzalutamideAbiraterone acetate Docetaxel
Prevalent prostate cancer in 2014
n = 386 127
Prevalent metastatic prostate cancer
n = 28 845 (7.5%)
Prevalent mCRPC
n = 12 951 (3.4%)
2014 population
Initiation of mCRPC specific treatment in 2014
n = 3 949
Prevalent CRPC
n = 18 973 (4.9%)
non-CRPCCastration resistant
n = 15 984 n = 12 951
metastaticnon-metastatic
n = 12 951 n = 6 022
Prevalent prostate cancer in 2012
n = 403 983
Prevalent metastatic prostate cancer
n = 36 524 (9.0%)
Prevalent mCRPC
n = 11 668 (2.9%)
2012 population
Initiation of mCRPC specific treatment in 2012
n = 2 921
Prevalent CRPC
n = 18 441 (4.6%)
non-CRPCCastration resistant
n = 24 856 n = 11 668
metastatic
n = 11 668
non-metastatic
n = 6 773