Treatment patterns and survival in men with metastatic castration-resistant prostate cancer (mCRPC): A systematic literature review of 35 real-world observational studies.

101 Background: Treatment landscapes have changed dramatically in prostate cancer in the past decade. Therapies like androgen receptor pathways inhibitors (ARPIs), which were initially approved for mCRPC are now approved in the earlier disease spectrum, including biochemical recurrence (BCR), non-metastatic castration-resistant prostate cancer (nmCRPC), and hormone-sensitive metastatic prostate cancer (mHSPC). Further, several other life-prolonging therapies, including radiopharmaceuticals, immunotherapies, and poly-ADP ribose polymerase inhibitors (PARPi), have been approved for mCRPC in the last decade. Given these changes, this systematic literature review (SLR) aimed to summarize treatment patterns and survival in patients with mCRPC. Methods: Electronic databases (PubMed, Embase) and key conferences (2022-2024) were searched systemically for real-world (RW) observational studies published between Jan 2015 and March 2024 that examined treatment patterns and survival in patients with mCRPC. A GenAI-powered literature review platform assisted in study selection alongside human validation, and independent reviewers extracted and assessed the data for narrative synthesis of key findings. Results: From 4,565 retrieved citations, 35 studies with a total of 86,131 patients with mCRPC met inclusion criteria. In most studies, patient median age ranged from 65 to 75. Studies predominantly utilized electronic medical records (EMR)/chart review (n=24), followed by a registry/-linked claims (n=10). Most studies were from North America (n=21; 18 United States; 3 Canada), followed by Europe (n=6), Asia (n=3), Oceania (n=3), and others (n=2). Bone and visceral metastases were present in ≥ 70% of mCRPC and ≤30% in most studies, respectively. ARPI was the most frequently utilized first line of therapy(1L) for mCRPC in all studies (≥50% in most studies), followed by chemotherapy, albeit with varying magnitude by geographic regions. Chemotherapy for 1L mCRPC was more common in Europe and Oceania than in the US. The use of radiopharmaceuticals, PARPIs, and immunotherapy was low in most studies (<10%) as 1L mCRPC. Most studies found ARPI to ARPI was the most common 1L to 2L mCRPC sequence, though in few studies, ARPI-chemotherapy was the common 1L to 2L mCRPC sequence. In most studies, median real-world overall survival ranged from 18 to 27 months and varied by genetic mutation status. Conclusions: Findings highlight that ARPI remained the most utilized 1L/2L in men with mCRPC, and back-to-back ARPI was also a common practice even after the availability of the other life-prolonging therapies. This SLR highlights the need to optimize treatment beyond systemic hormone therapy.