1
12% 21% 18% 18% 87% 77% 81% 80% NDx mHSPC Progressive mHSPC nmCRPC nmHSPC 48% 61% 72% 62% 46% 30% 21% 30% 4% 6% 4% 4% NDx mHSPC Progressive mHSPC nmCRPC nmHSPC 80.9% Doce. 17.5% Abi. Doce. 30.7% 61.9% Abi. 4.5% Enza. 1 Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France – 2 CHU de Bordeaux, Bordeaux, France – 3 Clinique Beau Soleil, Montpellier, France 4 CHU de Toulouse, Toulouse, France – 5 ESSEC, Cergy-Pontoise, France – 6 Janssen, Issy les Moulineaux, France Changes in therapeutic strategy in metastatic castration resistant prostate cancer (mCRPC) between 2012 and 2014 from the French nationwide claims database (SNDS) • The arrival of new therapeutic strategies has impacted mCRPC management: 8 out of 10 patients used docetaxel as 1 st line in 2012 whereas they were only 3 out of 10 in 2014, most of the remaining patients used abiraterone acetate (Table 1) Nicolas Thurin 1,2 *, Magali Rouyer 1 , Jérémy Jové 1 , Marine Gross-Goupil 2 , Thibaud Haaser 2 , Xavier Rébillard 3 , Michel Soulié 4 , Gérard de Pouvourville 5 , Camille Capone 6 , Marie Pierrès 6 , Stéphanie Lamarque 1 , Emmanuelle Bignon 1 , Cécile Droz-Perroteau 1 , Nicholas Moore 1,2 , Patrick Blin 1 • To describe patients characteristics according to the 1 st treatment lines in 2012 and 2014 • To describe treatment lines for mCRPC patients in 2012 an 2014 • To assess the therapeutic strategic changes for mCRPC between 2012 and 2014 35 th Annual European Association of Urology Congress March 20-24, 2020, Amsterdam, The Netherlands Poster #580 Declaration of interest statement: The CAMERRA study is carried out by the Bordeaux PharmacoEpi platform in collaboration with Janssen ® company and supervised by a Scientific Committee Ø Study design • Two cohorts of mCRPC patients identified using a validated algorithm and initiating a mCRPC specific treatment with a 5-year history prior index date and a 3-year follow-up: - 2012 cohort: patients initiating a 1 st treatment line for mCPRC in 2012 - 2014 cohort: patients initiating a 1 st treatment line for mCPRC in 2014 Ø Data source • SNDS: National Healthcare System database covering the overall French population from birth (or immigration) to death (or emigration), including all reimbursed claims from all French healthcare insurance schemes (e.g. drugs, medical visits, medical visits, etc.), hospital-discharge summaries from French public and privates hospitals (e.g. diagnostic codes, procedures, etc.) and the National death registry • Selection of patients ≥ 40 years, affiliated to the “Régime Général” insurance scheme (86% of French population) and having a complete healthcare historic Ø Setting • mCRPC 1 st line treatments: abiraterone acetate, docetaxel or enzalutamide, all drugs presumed to be used according to the Summary of Product Characteristics • Previous prostate cancer stages before mCRPC status defined according to the estimated date of castration resistance and the estimated date of 1 st metastasis management: - non-metastatic hormonosensitive prostate cancer (nmHSPC) - metastatic hormonosensitive prostate cancer newly diagnosed (NDx mHSPC) - progressive metastatic hormonosensitive prostate cancer (progressive mHSPC) - non-metastatic castration resistant prostate cancer (nmCRPC) Materials & Methods • Therapeutic strategy in metastatic castration-resistant prostate cancer (mCRPC) has evolved significantly with the introduction of new 1 st- line treatments since the end of 2012: - Abiraterone acetate in association with prednisone/prednisolone in December 2012 - Enzalutamide in November 2014 Background Conclusion • The algorithm, with a positive predictive value of 0.92, enabled the identification of respectively 11 668 prevalent mCRPC cases in 2012 and 12 951 in 2014. From them 2 921 patients initiated a first treatment for mCRPC in 2012 and 3 949 in 2014 • mCRPC prevalence may be slightly underestimated because of the sensitivity of the algorithm (76%) Results Figure 1. Identification of population in 2012 and 2014 from SNDS database Figure 4. Sequences of mCRPC treatment lines over the 3-year follow-up in 2012 and 2014 populations 2012 n = 2 921 2014 n = 3 949 Docetaxel 2 364 (80.9) 1 214 (30.7) Abiraterone acetate 511 (17.5) 2 444 (61.9) Enzalutamide 0 (0.0) 176 (4.5) Treatment line = at least 2 consecutive dispensing or infusion during follow-up Figure 2. Disease stage before mCRPC status in 2012 and 2014 CAMERRA populations Table 1. First treatment line over the 3-year follow-up for 2012 and 2014 populations • Over the 3-year follow-up, 63% of 2012 population and 58% of 2014 population received a 2 nd mCRPC treatment line (Figure 4): - In 2012: the 2 nd line was abiraterone acetate for 83% of the concerned patients - In 2014: the 2 nd line were enzalutamide and docetaxel for respectively 41% and 31% of the concerned patients • In 2012: - Docetaxel mainly used - Few variations according to the stage before mCRPC status • In 2014: - Abiraterone acetate mainly used in patients with previous stage of progressive mHSPC, nmHSPC and nmCRPC stages - Abiraterone acetate and docetaxel equally used in patients in patients with previous stage of NDx mHSPC 2012 2014 • Previous disease stages before mCRPC status barely changed between 2012 and 2014 Identification of 2012 and 2014 study population Disease stage before mCRPC status 1 st treatment line in mCRPC patients 1 st treatment line according to disease stage before mCRPC status Sequences of mCRPC treatment lines 2012 2014 47% nmHSPC 15% NDx mHSPC 18% Progressive mHSPC 20% nmCRPC 52% nmHSPC 15% NDx mHSPC 15% Progressive mHSPC 18% nmCRPC Objectives ü Between 2012 and 2014, the mCRPC 1 st -line treatment shifted from docetaxel for 4 out of 5 patients to abiraterone acetate for 3 out of 5 ü In 2014, docetaxel or enzalutamide were equally used in 2 nd -line after abiraterone acetate ü Disease stage before mCRPC seemed to have more impact in the treatment choice in 2014 than in 2012 Abiraterone acetate Docetaxel Enzalutamide Cabazitaxel Combination therapy No mCRPC treatment Death Figure 3. 1 st treatment line according to disease stage before mCRPC status in 2012 and 2014 2012 2014 Abiraterone acetate Docetaxel Enzalutamide Abiraterone acetate Docetaxel Prevalent prostate cancer in 2014 n = 386 127 Prevalent metastatic prostate cancer n = 28 845 (7.5%) Prevalent mCRPC n = 12 951 (3.4%) 2014 population Initiation of mCRPC specific treatment in 2014 n = 3 949 Prevalent CRPC n = 18 973 (4.9%) non-CRPC Castration resistant n = 15 984 n = 12 951 metastatic non-metastatic n = 12 951 n = 6 022 Prevalent prostate cancer in 2012 n = 403 983 Prevalent metastatic prostate cancer n = 36 524 (9.0%) Prevalent mCRPC n = 11 668 (2.9%) 2012 population Initiation of mCRPC specific treatment in 2012 n = 2 921 Prevalent CRPC n = 18 441 (4.6%) non-CRPC Castration resistant n = 24 856 n = 11 668 metastatic n = 11 668 non-metastatic n = 6 773
