Real-world use of bone modifying agents in metastatic, castration-resistant prostate cancer.

Abstract

BACKGROUND:

Bone modifying agents (BMAs) prevent skeletal related events among patients with metastatic, castration-resistant prostate cancer (mCRPC) involving bone and prevent osteoporotic fractures among patients at high risk. BMA utilization for patients with mCRPC has not been well quantified.

METHODS:

We used linked SEER registry and Medicare claims data. We included men diagnosed with stage IV prostate adenocarcinoma during 2007-2015, aged > = 66 at diagnosis, with sufficient continuous enrollment in Medicare Parts A, B, and D, who received androgen deprivation therapy. We limited to those who subsequently received a CRPC-defining treatment (CDT). We identified patients with evidence of bone metastasis using claims. Our primary outcome was receipt of a BMA (zoledronic acid or denosumab) within 180 days of initiating CDT.

RESULTS:

Among 1292 included patients, 1034 (80%) had bone metastasis. BMA use within 180 days of initiating CDT was higher among patients with bone metastases than those without (705/1034 [68%] vs 56/258 [22%]). Among patients without bone metastasis, those with high osteoporotic fracture risk were more likely than those without to receive a BMA (OR = 2.48, 95% CI: 1.17, 5.29); however, only 26% of patients with high fracture risk received a BMA. Among patients who received BMAs, most (62%) first initiated them >90 days before initiating CDT.

CONCLUSIONS:

Two-thirds of patients with mCRPC and bone metastases received BMAs within 180 days after initiating CDT. A greater proportion of patients without bone metastasis may warrant BMA therapy for osteoporotic fracture prevention. Some patients with bone metastasis may be able to delay BMA initiation until CRPC.

• Authors: Aaron P Mitchell, Akriti Mishra Meza, Katherine S Panageas, Allison Lipitz-Snyderman, Azeez Farooki, Michael J Morris
• Journal: Prostate cancer and prostatic diseases (Prostate Cancer Prostatic Dis) Vol. 26 Issue 1 Pg. 126-132 (03 2023) ISSN: 1476-5608 [Electronic] England
• PMID: 35798857 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• Androgen Antagonists
• Zoledronic Acid
• Bone Density Conservation Agents

Topics

• Male
• Humans
• Aged
• United States (epidemiology)
• Prostatic Neoplasms, Castration-Resistant (drug therapy, pathology)
• Androgen Antagonists
• Osteoporotic Fractures (chemically induced)
• Medicare
• Zoledronic Acid
• Bone Neoplasms (drug therapy, pathology)
• Bone Density Conservation Agents (therapeutic use)