Global treatment patterns for late-stage prostate cancer: Updated results from ASPIRE-PCa

ASPIRE-PCa is an observational study that aims to describe the pattern of care for men with late-stage prostate cancer (PC). 1200 patients (pts) from the Americas, Europe, Asia, and the Middle East/North Africa are targeted for enrolment. We present updated data from December 2015. Men with prostate adenocarcinoma enrol at the diagnosis of: biochemical failure after curative-intent therapy with a prostate-specific antigen (PSA) doubling time of ≤1 year; castration-resistant PC (CRPC); or metastatic PC (mPC) at initial presentation. Initial treatment decision and planned follow-up data were collected. 507 pts have enrolled from 72 sites in 21 countries: Americas, n = 53; Europe, n = 172; Asia, n = 271; and the Middle East/North Africa, n = 11. Biochemical failure, n = 90 (18%); CRPC, n = 181 (36%); mPC, n = 235 (46%); and missing, n = 1 (<1%). Initial treatment decision and planned follow-up data are available for 277 pts. Androgen deprivation therapy (ADT) was the treatment of choice, with disease status being the primary driver of treatment selection (table). Initial ADT data are available for 223 pts. A gonadotropin-releasing hormone (GnRH) agonist with anti-androgen (aa) for flare protection only, was the most selected ADT. This combination was used for total androgen blockade in 4 CRPC and 6 mPC pts. The most common GnRH agonist, aa, and 2nd-generation androgen-directed therapy were: leuprolide, n = 106 (48%); bicalutamide, n = 108 (48%); and abiraterone, n = 17 (8%), respectively (sum >100%, as >1 option/pt). Enzalutamide was less frequently chosen (n = 7; 3%). The most favoured follow-up was PSA testing every 3 months. Updated regional differences will be presented.Tabled 1New treatment,a n (%)277 (109%)Androgen-deprivation therapy244 (88%)Chemotherapy, immunotherapy, targeted therapy46 (17%)Salvage radiotherapy11 (4%)Androgen-deprivation therapy, n (%)223 (∼100%)GnRH agonist and anti-androgen90 (40%)GnRH agonist alone67 (30%)Anti-androgen alone26 (12%)2nd-generation androgen-directed therapy25 (11%)Treatment missing7 (3%)GnRH antagonist alone4 (2%)GnRH antagonist and anti-androgen2 (<1%)GnRH agonist and 2nd-generation androgen-directed therapy1 (<1%)Oestrogens1 (<1%)Most important factor for treatment selection,b831 factors for 277 patients (Up to 3 factors/patient).n (%)831 (∼100%)Disease status239 (29%)Efficacy data from literature131 (16%)Performance status109 (13%)Efficacy data from own experience82 (10%)Age60 (7%)Comorbidities49 (6%)Prior therapy49 (6%)Prior response46 (6%)Preference/request40 (5%)Insurance/cost19 (2%)Other7 (<1%)Follow-up method,aSum >100% (>1 option/patient)n (%); mean interval every x months (range)277 (253%)PSA275 (99%); 2.8 (1-6)Clinical exam235 (85%); 2.9 (1-6)Radiography192 (69%); 5.9 (3-12)GnRH, gonadotropin-releasing hormone; PSA, protein-specific antigen.a Sum >100% (>1 option/patient)b 831 factors for 277 patients (Up to 3 factors/patient). Open table in a new tab GnRH, gonadotropin-releasing hormone; PSA, protein-specific antigen. The updated results from ASPIRE-PCa indicate that most late-stage PC pts receive ADT as a GnRH agonist/aa combination; disease status drives treatment choice; and the most common follow-up is PSA testing every 3 months. Leuprolide and bicalutamide are the most common initial interventions.