CUSTOMIZATION OF A LARGE LANGUAGE MODEL APPROACH TO CAPTURE PSA AND IMAGING DERIVED REAL-WORLD PROGRESSION EVENTS IN PROSTATE CANCER
Author(s)
Kelly Magee, MS, FNP-BC1, Patrick Ward, PhD, MPH2, Wanjing Chen, MS2, Eunice Hankinson, MSN, FNP-C1, Aaron Dolor, PhD1;
1Flatiron Health, New York, NY, USA, 2Flatiron Health, Durham, NC, USA
1Flatiron Health, New York, NY, USA, 2Flatiron Health, Durham, NC, USA
OBJECTIVES: We have previously demonstrated the performance of an LLM-based approach to capturing real-world progression (rwP) from clinician documentation of worsening disease. However, prostate cancer (PC) progression often involves prostate-specific antigen (PSA) changes. We adapted our approach to incorporate PSA-based progression events and evaluated its performance using elements of the VALID framework.
METHODS: This study used the Flatiron Health Research Database, comprising 374,189 patients with PC. We assessed the completeness of rwP events overall and by the contribution of the clinician-documented approach and events derived from PSA changes among patients with metastatic hormone-sensitive PC (mHSPC) receiving first-line (1L) and metastatic castration-resistant PC (mCRPC) receiving 1L, second-line (2L), or third-line (3L) and with a metastatic diagnosis date after January 1, 2011. We evaluated the relationship between first rwP event following line start and clinically relevant downstream events (treatment change or death) and estimated progression-free survival (PFS) estimates by sites of metastases.
RESULTS: The proportion of patients with ≥1 rwP event was 53% in 1L mHSPC (n = 71,936) and 73%, 77%, and 77% in 1L (n = 46,663), 2L (n = 26,254), and 3L (n = 14,382) mCRPC. 49%-68% of patients experienced ≥1 clinician-documented event and 20%-36% experienced ≥1 PSA-only event. The percent of first rwP events associated with a downstream clinical event increased in later lines (39% in 1L mHSPC to 50% in 3L mCRPC) with higher rates among clinician documented events compared to PSA-only events (41%-57% vs. 23%-33%). When considering all progression events, PFS was shorter for patients with liver metastases compared with those with bone-only metastases (3.2 vs. 5.9 months in 1L mCRPC, 6.9 vs. 17.8 months in 1L mHSPC).
CONCLUSIONS: This study establishes the performance and validation of an LLM-based approach leveraging both clinician documentation and PSA data to capture progression events in patients with PC.
METHODS: This study used the Flatiron Health Research Database, comprising 374,189 patients with PC. We assessed the completeness of rwP events overall and by the contribution of the clinician-documented approach and events derived from PSA changes among patients with metastatic hormone-sensitive PC (mHSPC) receiving first-line (1L) and metastatic castration-resistant PC (mCRPC) receiving 1L, second-line (2L), or third-line (3L) and with a metastatic diagnosis date after January 1, 2011. We evaluated the relationship between first rwP event following line start and clinically relevant downstream events (treatment change or death) and estimated progression-free survival (PFS) estimates by sites of metastases.
RESULTS: The proportion of patients with ≥1 rwP event was 53% in 1L mHSPC (n = 71,936) and 73%, 77%, and 77% in 1L (n = 46,663), 2L (n = 26,254), and 3L (n = 14,382) mCRPC. 49%-68% of patients experienced ≥1 clinician-documented event and 20%-36% experienced ≥1 PSA-only event. The percent of first rwP events associated with a downstream clinical event increased in later lines (39% in 1L mHSPC to 50% in 3L mCRPC) with higher rates among clinician documented events compared to PSA-only events (41%-57% vs. 23%-33%). When considering all progression events, PFS was shorter for patients with liver metastases compared with those with bone-only metastases (3.2 vs. 5.9 months in 1L mCRPC, 6.9 vs. 17.8 months in 1L mHSPC).
CONCLUSIONS: This study establishes the performance and validation of an LLM-based approach leveraging both clinician documentation and PSA data to capture progression events in patients with PC.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD123
Topic
Real World Data & Information Systems
Disease
SDC: Oncology