University of Toronto Faculty of Medicine
Management of castrate resistant prostate cancer: Real world evidence in a regional cancer centre
Emily Evans1, Christopher Tran1, Adree Khondker1, Jethro CC Kwong2, Amna Ali3, Andrew H Feifer2,3,4.
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; 3Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada; 4Carlo Fidani Regional Cancer Center, Trillium Health Partners, Mississauga, ON, Canada
Introduction: In 2013, the Advanced Prostate Cancer Clinic at Trillium Health Partners was founded to support a growing population of castrate resistant prostate cancer (CRPC) patients managed in the community setting. Herein, we provide our preliminary real-world experience with evidenced-based CRPC management in a regional cancer centre setting.
Methods: We conducted a retrospective review of institutional CRPC patients from 2012-2019. Both metastatic (mCRPC) and non-metastatic (nmCRPC) patients were included. Descriptive analyses, management patterns, and cohort survival characteristics are presented.
Results: We identified 271 patients, 217 (80.0% mCRPC), with a median duration of follow-up of 16 months. Median time from initiation of ADT to CRPC was 27 months. Median PSA and ECOG at CRPC were 15.1 ng/mL and 2, respectively. Enzalutamide was used as primary therapy in nmCRPC and mCRPC patients in 48.15% (n=26) and 36.40% (n=79) patients respectively. Abiraterone was the primary treatment used in 116 mCRPC patients (53.46%). Second line therapies are listed in Figure 1. In the nmCRPC cohort, median OS was 63 months (95%CI = 18.0–108.0), and median radiographic progression free survival (rPFS) was 41 months (95%CI = 31.1–50.9). Median time from nmCRPC to mCRPC (n = 15) was 13 months (95%CI = 6–31). Median OS and rPFS for the mCRPC patients were 48.0 (95%CI = 37.5-58.5) and 14 months (95%CI = 10.9-17.1) respectively.
Conclusion: There is an emergent need for regionalized models of care in advanced prostate cancer as a result of earlier introduction of androgen receptor axis therapies to routine patient therapy. Our experience validates that comprehensive, evidenced-based care is possible in the regional community cancer centre setting. Our data further supports the development of regionalized solutions for advanced prostate cancer management, tailored to the plurality of treatment settings across Canada.
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