Amanda Ribbands

We investigated the real-world criteria and thresholds physicians use to classify patients with nonmetastatic castration-sensitive prostate cancer with biochemical recurrence as high risk, and how these align with guidelines. Descriptive analyses were conducted using data abstracted from an independent, retrospective, cross-sectional survey completed by urologists and radiation oncologists in the USA between April and November 2023. Physicians provided their perspectives and extracted chart data for the last 6-8 patients they diagnosed with high-risk biochemical recurrence. The cohort included 87 physicians (79% urologist, 21% radiation oncologist), who reported data for 460 patients. Physicians believed in using multiple factors for risk stratification, notably prostate-specific antigen doubling time (94%), absolute prostate-specific antigen rise following definitive therapy (89%), and Gleason score (87%). Over half named prostate-specific antigen doubling time as the most important factor. Physicians used a median (interquartile range) prostate-specific antigen doubling time threshold of 6.0 (6.0-9.0) months when identifying patients with high-risk biochemical recurrence. At the patient level, prostate-specific antigen doubling time (58%), Gleason score (44%), and absolute prostate-specific antigen rise following definitive therapy (43%) were the most frequently reported factors used for determining high-risk biochemical recurrence in the real world. Physicians use multiple clinical factors to identify high-risk biochemical recurrence. These factors generally align with guidelines. However, physicians generally used a more restrictive prostate-specific antigen doubling time threshold than many guidelines recommend. Discrepancies present an opportunity for further education, potentially expanding the pool of patients with high-risk biochemical recurrence who may benefit from recent advances in management.

Introduction Based upon recent phase 3 trials, guidelines recommend early aggressive treatment for patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer. We assessed how this aligns with current real-world treatment patterns. Methods Descriptive analyses were performed on data abstracted from an independent, retrospective, cross-sectional survey, which collected information regarding treatment from urologists and radiation oncologists in the United States between April and November 2023 who were managing patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer. Data were derived from physician responses to questions regarding their perspectives on treatment and patient record forms for their last 6–10 patients with high-risk biochemical recurrence. Although the survey was retrospective in nature and not based on a true random sample of physicians and patients, the relatively minimal inclusion criteria used attempted to ensure a broad representation of physicians and patients with high-risk biochemically recurrent prostate cancer. Results An analysis cohort of 87 physicians submitted data for 535 eligible patients. Median time from diagnosis with high-risk biochemical recurrence to first-line treatment was 20 days. Median time between high-risk biochemical recurrence diagnosis and end of data collection was 286 days. The most common first-line treatments were androgen deprivation therapy alone (28%), radiation (20%), androgen receptor pathway inhibitor + androgen deprivation therapy (19%), and observation (13%). Among patients who received androgen deprivation therapy, 79% received it continuously. Adherence to treatment guidelines (cited by 49%) was the most common reason for physicians’ first-line treatment choice. Conclusions In our real-world analysis, patients with high-risk biochemically recurrent prostate cancer rapidly received first-line treatment after diagnosis. The top reason for treatment choice was adherence to guidelines. Our finding that patients with biochemical recurrence are promptly treated in the real world aligns with guidance suggesting clinical benefit of early intervention.

This study described treatment patterns, reasons for treatment, and homologous recombination repair mutation (HRRm) testing patterns in a real-world metastatic castration-resistant prostate cancer (mCRPC) population in Europe. Data were drawn from the Adelphi Prostate Cancer Disease Specific Programme™, a cross-sectional survey of physicians and patients conducted in France, Germany, Italy, Spain, and the United Kingdom, November 2022-May 2023. Physicians provided clinical characteristics, treatment and HRRm testing patterns, and reasons for treatment for eight consecutive patients with mCRPC. Most analyses were descriptive; treatment reasons were compared using Fisher's Exact test. Physicians provided data for 1,737 mCRPC patients. Most patients (73%) were androgen receptor pathway inhibitor (ARPi)-naïve at first-line (1 L) mCRPC. Here, at 1 L mCRPC, 60% of patients received ARPi and 24% chemotherapy. Of those who received ARPi prior to mCRPC (n = 291), 60% received chemotherapy at mCRPC and 21% ARPi. Overall, 37% were HRRm tested. Treatment patterns, sequencing, reasons, and HRRm testing varied by country, physician specialty, and practice setting. Treatment patterns generally followed guidelines. ARPi prescriptions prior to mCRPC were numerically higher than previously reported, however HRRm testing rates were still low meaning mCRPC patients may miss out on more effective targeted treatments.

Multiple myeloma (MM) is a hematological malignancy associated with poor health-related quality of life (HRQoL). Safe and effective treatments for MM are limited. There is a need for real-world data to improve understanding of treatment patterns and sequencing in routine clinical practice in Japan. This study evaluated disease burden, treatment patterns, treatment sequencing, and reasons for treatment selection in patients with MM in Japan. This analysis used survey data of hematologists or hemato-oncologists and their adult patients with MM who received active treatment in a real-world setting in Japan between September 2022 and May 2023. Treatment and retreatment patterns and data from several validated patient reported outcome tools were analyzed. Formal sample size calculations were not applicable. Fifty-one physicians provided data for 309 patients, of whom 52 completed a quality-of-life survey (median [interquartile range] overall health status by EQ-5D-3L questionnaire: 0.7 [0.6-1.0]). Of 309 patients, most (77%) of the first-line cohort received a lenalidomide-based therapy. Lenalidomide retreatment was common in patients with relapsed/refractory MM (80%). Poor HRQoL and high retreatment rates indicate a need for new therapy options in patients with MM in Japan. These findings may guide healthcare policies and clinical practice in Japan.

Aim: To investigate treatment patterns, healthcare resource utilization and disease burden in patients with multiple myeloma (MM). Methods: Point-in-time survey of physicians and their patients pre... Plain language summary There are many new treatments available for patients with multiple myeloma. While outcomes such as survival, symptoms and health problems experienced have improved, patients ... Tweetable abstract Despite improvements in the treatment of multiple myeloma, patients still experience symptoms and disease burden, all of which impact on healthcare resource use. Patients who are...

Aim: To explore treatment selection for relapsed/refractory multiple myeloma (RRMM), which remains complex due to heterogeneity of available treatments and lack of defined standard of care. Patient... Plain language summary Multiple myeloma (MM) is an incurable cancer of white blood cells. Treatments tend to become less effective when taken for long periods of time, meaning that patients often r...

Purpose: We aimed to explore patient-reported outcomes (PROs) and patient and physician concordance of side effects perception across lines of therapy (LOT) in multiple myeloma (MM) within the United States of America (USA). Methods: Data were drawn from the Adelphi Real World MM III Disease Specific Programme™, a point-in-time survey of hemato-oncologists/hematologists and their patients with MM conducted in the USA between August 2020 and July 2021. Physicians reported patient characteristics and side effects. Patients reported side-effect bother and health-related quality of life (HRQoL) using validated PRO tools (European Organisation for the Research and Treatment of Cancer Quality of Life Core Questionnaire/-MM Module [EORTC QLQ-C30/-MY20], EQ-5D-3L and Functional Assessment of Cancer Therapy—General Population physical item 5). Descriptive, linear regression and concordance analyses were performed. Results: Records from 63 physicians and 132 patients with MM were analyzed. EORTC QLQ-C30/-MY20 and EQ-5D-3L scores were consistent across LOTs. Scores tended to be worse with higher side-effect bother; patients “very much” bothered by side effects had lower median (interquartile range) global health status scores (33.3 [25.0–50.0]) than those “not at all” bothered (79.2 [66.7–83.3]). Patient and physician concordance on side-effect reporting was poor to fair. Patients frequently reported fatigue and nausea as bothersome side effects. Conclusion: HRQoL of patients with MM was worse with greater side-effect bother. Discordant patient and physician reporting of side effects indicated a need for improved communication during management of MM.

There is limited real-world evidence on how increasing use of treatment intensification in metastatic castration-sensitive prostate cancer (mCSPC) has influenced treatment decisions in metastatic castration-resistant prostate cancer (mCRPC). The study objective was to evaluate the impact of novel hormonal therapy (NHT) and docetaxel use in mCSPC on first-line treatment patterns among patients with mCRPC in 5 European countries and the United States (US). Physician-reported data on patients with mCRPC from the Adelphi Prostate Cancer Disease Specific Program were descriptively analyzed. A total of 215 physicians provided data on 722 patients with mCRPC. Across 5 European countries and the US, 65% and 75% of patients, respectively, received NHT, and 28% and 9% of patients, respectively, received taxane chemotherapy as first-line mCRPC treatment. In Europe, patients who had received NHT in mCSPC (n = 76) mostly received taxane chemotherapy in mCRPC (55%). Patients who had received taxane chemotherapy, or who did not receive taxane chemotherapy or NHT in mCSPC (n = 98 and 434, respectively) mostly received NHT in mCRPC (62% and 73%, respectively). In the US, patients who had received NHT, taxane chemotherapy, or neither in mCSPC (n = 32, 12, and 72, respectively) mostly received NHT in mCRPC (53%, 83%, and 83%, respectively). Two patients in Europe were rechallenged with the same NHT. These findings suggest that physicians consider mCSPC treatment history when making first-line treatment decisions in mCRPC. Further studies are needed to better understand optimal treatment sequencing, especially as new treatments emerge.

Background: Continuous androgen deprivation therapy ± first-generation non-steroidal antiandrogen was previously the standard-of-care for patients with metastatic castration-sensitive prostate cancer (mCSPC). Treatment intensification with novel hormonal therapy (NHT) or taxane chemotherapy is now approved and guideline-recommended for these patients. Methods: Physician-reported data on adult patients with mCSPC from the Adelphi Prostate Cancer Disease Specific Programme were analyzed descriptively. We evaluated real-world treatment trends for patients with mCSPC in 5 European countries (United Kingdom, France, Germany, Spain, and Italy) and the United States (US), looking at differences between patients initiating treatment in 2016-2018 and in 2019-2020. We also investigated treatment trends by ethnicity and insurance status in the US. Results: This study found that most patients with mCSPC do not receive treatment intensification. However, greater use of treatment intensification with NHT and taxane chemotherapy was observed in 2019-2020 than in 2016-2018 across 5 European countries. In the US, greater use of treatment intensification with NHT in 2019-2020 than in 2016-2018 was observed for all ethnicity groups and those with Medicare and commercial insurance status. Conclusions: As the number of patients with mCSPC who receive treatment intensification increases, more patients who progress to metastatic castration-resistant prostate cancer (mCRPC) will have been exposed to intensified treatments. Treatment options for patients with mCSPC and mCRPC overlap, suggesting that an unmet need will emerge for new therapies. Further studies are needed to understand optimal treatment sequencing in mCSPC and mCRPC.