Real-world treatment patterns and genetic testing in a metastatic castration-resistant prostate cancer setting in Europe

This study described treatment patterns, reasons for treatment, and homologous recombination repair mutation (HRRm) testing patterns in a real-world metastatic castration-resistant prostate cancer (mCRPC) population in Europe. Data were drawn from the Adelphi Prostate Cancer Disease Specific Programme™, a cross-sectional survey of physicians and patients conducted in France, Germany, Italy, Spain, and the United Kingdom, November 2022–May 2023. Physicians provided clinical characteristics, treatment and HRRm testing patterns, and reasons for treatment for eight consecutive patients with mCRPC. Most analyses were descriptive; treatment reasons were compared using Fisher’s Exact test. Physicians provided data for 1,737 mCRPC patients. Most patients (73%) were androgen receptor pathway inhibitor (ARPi)-naïve at first-line (1 L) mCRPC. Here, at 1 L mCRPC, 60% of patients received ARPi and 24% chemotherapy. Of those who received ARPi prior to mCRPC (<i>n</i> = 291), 60% received chemotherapy at mCRPC and 21% ARPi. Overall, 37% were HRRm tested. Treatment patterns, sequencing, reasons, and HRRm testing varied by country, physician specialty, and practice setting. Treatment patterns generally followed guidelines. ARPi prescriptions prior to mCRPC were numerically higher than previously reported, however HRRm testing rates were still low meaning mCRPC patients may miss out on more effective targeted treatments. Over the past 10 years, a range of new treatment options for metastatic castration-resistant prostate cancer (mCRPC) have become available. These include new hormonal treatments that target cell growth and more advanced treatments that target specific gene mutations. With new treatment options, it is important we understand how these new treatments are prescribed in clinical practice, how these relate to guideline recommendations, and how eligibility for advanced targeted therapies is established. Here, we look at how physicians prescribe new hormonal treatments and chemotherapy in real-world clinical practice, and how physicians test for eligibility for more advanced targeted treatments. We used data from a large multinational survey of physicians and their patients with mCRPC to find when in the treatment pathway, and in what order, treatments were prescribed, across all treatments for metastatic prostate cancer, treatment duration, reasons why treatments were chosen and genetic testing patterns. We found that most patients had not received a new hormonal treatment at development of mCRPC, with two-thirds receiving one as their first treatment for mCRPC. Of those that did receive new hormonal treatments before mCRPC developed, two-thirds received chemotherapy as their first treatment for mCRPC. Less than half of patients received genetic testing. Treatment patterns, order, reasons, and genetic testing rates varied by country, physician specialty, and practice setting. Though treatment patterns generally followed guidelines, with new hormonal treatments prescribed earlier more frequently than previously reported, genetic testing rates were still low meaning people with mCRPC may miss out on effective targeted treatments.