Real World Treatment Patterns, Genetic Testing, and Clinical Outcomes among Patients with mCRPC Treated with Olaparib Monotherapy in US Urology Clinics
Author(s)
Neal D Shore, MD1, Chinelo Orji, PhD2, Kumar Mukherjee Mukherjee, MS, PhD3, Lorraine O'Donnell, MBA, MS4, Audrey Himes, BA4, Lai Peng, MS4, Katie Grant, RN4, James Eller, MBA4, Sameer Ghate, PhD2.
1Carolina Urologic Research Center, Myrtle Beach, SC, USA, 2Merck & Co., Rahway, NJ, USA, 3AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA, 4Cardinal Health, Cleveland, OH, USA.
1Carolina Urologic Research Center, Myrtle Beach, SC, USA, 2Merck & Co., Rahway, NJ, USA, 3AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA, 4Cardinal Health, Cleveland, OH, USA.
Presentation Documents
OBJECTIVES: Olaparib is an approved PARP inhibitor (PARPi) for treating metastatic castration-resistant prostate cancer (mCRPC), in patients with HRR mutations (HRRm) following treatment with abiraterone acetate with prednisone (abi) or enzalutamide (enza). Despite its approval in 2020, there is limited real-world evidence on olaparib’s effectiveness as monotherapy for mCRPC. This study examines demographics, genetic testing patterns, treatment patterns and sequences, and clinical outcomes of mCRPC patients treated with olaparib monotherapy.
METHODS: This retrospective, observational cohort study included patients with mCRPC in US community urology practices who started olaparib monotherapy between June 2020-December 2023. All patients received abi or enza following initial prostate cancer diagnosis and prior to olaparib monotherapy. All patients had documentation of at least one positive HRRm (BRCA1, BRCA2, ATM, BRIP1, BARDI1, CDK12, CHEK1, CHECK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L).
RESULTS: The cohort included 200 patients, median age 74.5 years, 68.5% White, 18.4% African American, 2.5% Asian, 0.5% Hispanic or Latino, and 10% Other/Unknown. Previous pre-mCRPC therapies included androgen receptor pathway inhibitors (ARPIs) (abi, enza, apalutamide and darolutamide) in 45% of the cohort. In addition to therapeutic selection by a urologist, 53.5% also consulted with an oncologist. Patient genetic testing results included 41.5% BRCA-positive (BRCA1 only 6%, BRCA2 only 27.5%, and co-mutation with HRRm 8%), 11% had somatic testing, 89% germline testing and only 17% were tested prior to mCRPC diagnosis. Olaparib monotherapy was used primarily in 2L+ mCRPC setting (92.5%). Median real-world overall survival (rwOS) was 20 months and real-world time on treatment (rwToT) was 7 months.
CONCLUSIONS: This study highlights contemporary real-world treatment and testing patterns, and clinical outcomes associated with HRRm mCRPC patients treated with olaparib monotherapy. This data suggests the opportunity for earlier treatment with olaparib monotherapy which may improve rwOS in patients with mCRPC whose disease has progressed after receiving an ARPI.
METHODS: This retrospective, observational cohort study included patients with mCRPC in US community urology practices who started olaparib monotherapy between June 2020-December 2023. All patients received abi or enza following initial prostate cancer diagnosis and prior to olaparib monotherapy. All patients had documentation of at least one positive HRRm (BRCA1, BRCA2, ATM, BRIP1, BARDI1, CDK12, CHEK1, CHECK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L).
RESULTS: The cohort included 200 patients, median age 74.5 years, 68.5% White, 18.4% African American, 2.5% Asian, 0.5% Hispanic or Latino, and 10% Other/Unknown. Previous pre-mCRPC therapies included androgen receptor pathway inhibitors (ARPIs) (abi, enza, apalutamide and darolutamide) in 45% of the cohort. In addition to therapeutic selection by a urologist, 53.5% also consulted with an oncologist. Patient genetic testing results included 41.5% BRCA-positive (BRCA1 only 6%, BRCA2 only 27.5%, and co-mutation with HRRm 8%), 11% had somatic testing, 89% germline testing and only 17% were tested prior to mCRPC diagnosis. Olaparib monotherapy was used primarily in 2L+ mCRPC setting (92.5%). Median real-world overall survival (rwOS) was 20 months and real-world time on treatment (rwToT) was 7 months.
CONCLUSIONS: This study highlights contemporary real-world treatment and testing patterns, and clinical outcomes associated with HRRm mCRPC patients treated with olaparib monotherapy. This data suggests the opportunity for earlier treatment with olaparib monotherapy which may improve rwOS in patients with mCRPC whose disease has progressed after receiving an ARPI.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD88
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology