Population-based Analysis of Treatment Toxicity Among Men With Castration-resistant Prostate Cancer: A Phase IV Study

Christopher J.D. Wallis, Raj Satkunasivam, Refik Saskin, Symron Bansal, Girish S. Kulkarni, Urban Emmenegger, Robert K. Nam

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)138-145
Number of pages8
JournalUrology
Volume113
DOIs
StatePublished - Mar 2018

ASJC Scopus subject areas

  • Urology

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