Real-World Treatment Patterns and Survival in People With Metastatic Castration-Resistant Prostate Cancer Following Metastatic Hormone-Sensitive Disease Between 2020 and 2023 in the United States.

Purpose: To examine treatment patterns and survival in people with metastatic castration-resistant prostate cancer (mCRPC) previously progressing from metastatic hormone-sensitive prostate cancer (mHSPC) in the United States.

Methods: People diagnosed with mCRPC between January 1, 2020-June 30, 2023 were retrospectively identified in the ConcertAI NLP360™ electronic medical records (EMR) database. Inclusion criteria were prior diagnosis of mHSPC and ≥1 EMR encounter ≥12 months pre-mCRPC and ≥6 months post-mCRPC.

Results: Among 609 people identified, the most common prior treatment for mHSPC was androgen deprivation therapy (ADT) alone (53%); others included ADT plus abiraterone (ABI; 19%), ADT plus a non-ABI androgen receptor pathway inhibitor (ARPI; 18%) and ADT plus docetaxel (10%). Overall, the most common first-line (1L) therapies for mCRPC were a non-ABI ARPI (37%; most commonly enzalutamide [24%]), ABI (25%), and chemotherapy (22%). These were also the most common 1L mCRPC therapies for those receiving ADT alone or ADT plus docetaxel for mHSPC. Among those who received ADT plus ABI or a non-ABI ARPI for mHSPC, 50% and 40%, respectively, also received an ARPI 1L for mCRPC. 1L chemotherapy for mCRPC was more common following ADT combination regimens (24%-41%) than ADT alone (12%) for mHSPC. Median real-world overall survival was 27.2 months from mCRPC diagnosis and 20.8 months from 1L therapy.

Conclusion: Back-to-back ARPI use from mHSPC to mCRPC is common in current clinical practice and survival remains <3 years. Alternative mCRPC treatments, such as intensified combination regimens beyond androgen receptor targeting, require exploration to improve survival in mCRPC.