Trends in prescribing preferences (PPrefs) of U.S.-based oncologists for patients (Pts) with metastatic castrate-resistant prostate cancer (mCRPC) following docetaxel (DO).

Authors

Charles Ryan

Charles J. Ryan

UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA

Charles J. Ryan , Won Kim , Arden Buettner , Susan Lynne Britton , Maria L. Lankford , Doug B. Neely , Mark R. Green

Organizations

UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, University of California, San Francisco, San Francisco, CA, Xcenda, Tampa, FL, Xcenda, Palm Harbor, FL

Research Funding

No funding sources reported

Background: PPrefs of 467 US-based medical oncologists (MOs) in post-DO mCRPC pts were studied prospectively. A validated, proprietary, live, case-based market research tool was utilized with a core case scenario and 4 distinct treatment (Rx) outcomes following chemotherapy (CTx). Data were acquired using blinded audience response technology. Research support sources were double blinded. Methods: Core case: 59 y/o status post (s/p) radical prostatectomy with PSA failure after 15 months (mo), s/p salvage pelvic radiation (RT) → presents with rise in PSA and 3.5cm pelvic lymph node 16mo following RT→ progresses through multiple Rx over the next 42mo, including combined androgen blockade, anti-androgen withdrawal, sipuleucel-T and abiraterone (ABI). Now starting DO CTx due to increasing bone metastases and bone pain (BP). PPrefs for 4 variant scenarios of DO CTx were probed: (1) DO 75 mg/m2Q3wk x 6 cycles (cy) →Resolution of BP/PSA response → DO held due to cumulative myelosuppression/fatigue. Pt more active off CTx, ECOG PS 1. 3mo later →asymptomatic 30% rise in PSA. (2) DO x 4 cy → decrease in PSA, BP, node size. Prior to cy 6, has asymptomatic PSA progression. (3) DO x 4 cy→ decrease in PSA, BP, node size. Prior to cy 6, has both PSA and BP progression. (4) DO x 2 cy → progression with increased BP, PSA, and pelvic nodal disease. Results: See Table. Conclusions: PPrefs after DO CTx were outcome-dependent. In the absence of BP, ENZ is the most common PPref, even in this ABI-refractory pt. PPref for R223 over 2nd line CTx in the acquired symptomatic resistance setting is notable. PPref for 2nd line CTx increases with rapid, symptomatic disease progression.

Therapy preferences across variant scenarios (VS).

Rx optionsVS 1:
PSA rise after
DO response and
then DO holiday
(N=473)
VS 2:
Acquired PSA
resistance to DO
(N=469)
VS 3:
Acquired Symptomatic
resistance to DO
(N=466)
VS 4:
Primary resistance
to DO
(N=458)
Surveillance37%N/ON/ON/O
ABIN/O12%6%3%
Radium ra 223 (R223)1%6%41%22%
Cabazitaxel (CBZ)9%30%27%47%
Enzalutamide (ENZ)31%31%15%12%
ENZ-P13%10%7%6%
Mitoxantrone01%03%
Other9%10%4%7%

Abbreviations: N/O, not offered.

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Abstract Details

Meeting

2015 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

General Poster Session B: Prostate, Penile, Testicular, and Urethral Cancers, and Urothelial Carcinoma

Track

Urothelial Carcinoma,Prostate Cancer,Penile, Urethral, and Testicular Cancers

Sub Track

Prostate Cancer - Advanced Disease

Citation

J Clin Oncol 33, 2015 (suppl 7; abstr 243)

DOI

10.1200/jco.2015.33.7_suppl.243

Abstract #

243

Poster Bd #

C12

Abstract Disclosures