TY - JOUR
T1 - Population-based Analysis of Treatment Toxicity Among Men With Castration-resistant Prostate Cancer
T2 - A Phase IV Study
AU - Wallis, Christopher J.D.
AU - Satkunasivam, Raj
AU - Saskin, Refik
AU - Bansal, Symron
AU - Kulkarni, Girish S.
AU - Emmenegger, Urban
AU - Nam, Robert K.
N1 - Funding Information:
Funding Support: C.J.D.W. is supported by the Canadian Institute of Health Research Banting and Best Doctoral Award . R.K.N. is supported by the Ajmera Family Chair in Urologic Oncology . The funding organization had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. This study made use of deidentified data from the Institute for Clinical Evaluative Sciences Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research, and the Government of Ontario. The opinions, results, and conclusions reported are those of the authors. No endorsement by Institute for Clinical Evaluative Sciences or any of its funders or partners is intended or should be inferred.
Publisher Copyright:
© 2017 The Authors
PY - 2018/3
Y1 - 2018/3
N2 - Objective: To assess the toxicity and effectiveness of contemporary metastatic castrate-resistant prostate cancer (mCRPC) treatments at a population level, among all patients in Ontario particularly treated with newer agents, including abiraterone, enzalutamide, docetaxel, and cabazitaxel. Methods: We performed a population-based, retrospective cohort study of 2439 men aged ≥65 years treated for mCRPC with abiraterone, enzalutamide, docetaxel, or cabazitaxel from 2003 to 2015 in Ontario, Canada. Our primary outcome was treatment-related toxicity, defined as hospitalizations and emergency room (ER) visits during mCRPC treatment. Based on toxicity profiles identified during phase III trials, we further identified specific treatment-related toxicity. We calculated hazard ratios (HRs) using multivariable Cox proportional hazards models with time-varying exposures. Results: Abiraterone and enzalutamide exposure were not associated with any-cause (P =.19 and.52, respectively) or treatment-related (P =.45 and.64, respectively) toxicities. In contrast, docetaxel exposure was associated with an increased risk of any-cause (HR 1.29, 95% confidence interval [CI] 1.15-1.44) and treatment-related (HR 1.52, 95% CI 1.33-1.74) toxicities. Cabazitaxel exposure was associated with a significant risk of treatment-related toxicity (HR 5.94, 95% CI 1.87-18.92) but not any-cause toxicity (HR 2.37, 95% CI 0.59-9.63). Conclusion: Among patients with mCRPC, we failed to show any increased risk of hospitalizations and ER visits for treatment-related complications for abiraterone or enzalutamide. In contrast, treatment with intravenous chemotherapeutic agents was associated with an increased risk of hospitalizations and ER visits to manage these complications.
AB - Objective: To assess the toxicity and effectiveness of contemporary metastatic castrate-resistant prostate cancer (mCRPC) treatments at a population level, among all patients in Ontario particularly treated with newer agents, including abiraterone, enzalutamide, docetaxel, and cabazitaxel. Methods: We performed a population-based, retrospective cohort study of 2439 men aged ≥65 years treated for mCRPC with abiraterone, enzalutamide, docetaxel, or cabazitaxel from 2003 to 2015 in Ontario, Canada. Our primary outcome was treatment-related toxicity, defined as hospitalizations and emergency room (ER) visits during mCRPC treatment. Based on toxicity profiles identified during phase III trials, we further identified specific treatment-related toxicity. We calculated hazard ratios (HRs) using multivariable Cox proportional hazards models with time-varying exposures. Results: Abiraterone and enzalutamide exposure were not associated with any-cause (P =.19 and.52, respectively) or treatment-related (P =.45 and.64, respectively) toxicities. In contrast, docetaxel exposure was associated with an increased risk of any-cause (HR 1.29, 95% confidence interval [CI] 1.15-1.44) and treatment-related (HR 1.52, 95% CI 1.33-1.74) toxicities. Cabazitaxel exposure was associated with a significant risk of treatment-related toxicity (HR 5.94, 95% CI 1.87-18.92) but not any-cause toxicity (HR 2.37, 95% CI 0.59-9.63). Conclusion: Among patients with mCRPC, we failed to show any increased risk of hospitalizations and ER visits for treatment-related complications for abiraterone or enzalutamide. In contrast, treatment with intravenous chemotherapeutic agents was associated with an increased risk of hospitalizations and ER visits to manage these complications.
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U2 - 10.1016/j.urology.2017.08.067
DO - 10.1016/j.urology.2017.08.067
M3 - Article
C2 - 29191639
AN - SCOPUS:85039074263
SN - 0090-4295
VL - 113
SP - 138
EP - 145
JO - Urology
JF - Urology
ER -