REAL-WORLD FIRST-LINE TREATMENT (TX) PATTERNS IN ANDROGEN RECEPTOR PATHWAY INHIBITOR (ARPI)-EXPERIENCED METASTATIC CASTRATION-RESISTANT PROSTATE CANCER (MCRPC) BY RACE/ETHNICITY AND AREA-LEVEL SOCIOECONOMIC STATUS (SES) IN THE US
Author(s)
Pedro Barata, MD, MSc1, Agnes Hong, PharmD, MS2, Brendan T. Kerr, MS3, David Russell, MD2, Betty Thompson, PhD, MSc2, John Garretson, PhD2, jonathan assayag, PhD2, Eunice Hankinson, MSN, FNP-C3, Gene G. Ho, MPH3, Valeria Merla, MPH2, Neeraj Agarwal, MD4.
1Department of Medicine, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA, 2Pfizer Inc, New York, NY, USA, 3Flatiron Health, New York, NY, USA, 4Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
1Department of Medicine, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA, 2Pfizer Inc, New York, NY, USA, 3Flatiron Health, New York, NY, USA, 4Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
OBJECTIVES: There is limited real-world evidence describing tx patterns after ARPI exposure in mCRPC, particularly across racial, ethnic, and socioeconomic subgroups. We evaluated first-line (1L) mCRPC tx utilization by race, ethnicity, and area-level SES in ARPI-experienced patients (pts) in the US.
METHODS: This retrospective cohort study used the Flatiron Health Research Database and included pts diagnosed with mCRPC between January 2023 and August 2024 with evidence of ARPI prior to mCRPC diagnosis (dx) and life-prolonging systemic therapy in the mCRPC setting. Demographics and tx patterns were described overall and stratified by race/ethnicity and area-level SES quintiles, derived from the 2015-2019 American Community Survey (US Census Bureau).
RESULTS: Among 667 pts in the analytic cohort, 56.4% were non-Hispanic (NH) White, 12.4% were NH Black, and 14.2% and 18.7% resided in areas within the lowest and highest SES levels, respectively. Prior abiraterone exposure was observed in 42.7% of pts. The most common 1L mCRPC regimens were ARPI±androgen deprivation therapy (ADT) (36.3%) and chemotherapy±ADT (26.2%). Compared with NH White pts, NH Black pts were younger (54.3% ≥ 75 years vs 27.7%), more likely to reside in the lowest SES areas (10.6% vs 27.7%), had a higher median prostate-specific antigen (PSA) levels at metastatic dx (36.3 vs 154.5 ng/mL) and were more likely to receive chemotherapy±ADT than ARPI±ADT in 1L mCRPC (25.0% vs 32.5%). Similarly, pts in the lowest SES quintile were younger (41.1% ≥ 75 years vs 52.0%) and more frequently treated with chemotherapy±ADT than those in the highest quintile (30.5% vs 26.4%).
CONCLUSIONS: This study demonstrates clinically meaningful heterogeneity in 1L mCRPC tx selection and ARPI reuse across racial/ethnic groups and area-level SES. These findings underscore the need to better understand how social determinants of health influence tx decision-making and access to therapies in mCRPC, and to inform strategies aimed at reducing inequities in care delivery.
METHODS: This retrospective cohort study used the Flatiron Health Research Database and included pts diagnosed with mCRPC between January 2023 and August 2024 with evidence of ARPI prior to mCRPC diagnosis (dx) and life-prolonging systemic therapy in the mCRPC setting. Demographics and tx patterns were described overall and stratified by race/ethnicity and area-level SES quintiles, derived from the 2015-2019 American Community Survey (US Census Bureau).
RESULTS: Among 667 pts in the analytic cohort, 56.4% were non-Hispanic (NH) White, 12.4% were NH Black, and 14.2% and 18.7% resided in areas within the lowest and highest SES levels, respectively. Prior abiraterone exposure was observed in 42.7% of pts. The most common 1L mCRPC regimens were ARPI±androgen deprivation therapy (ADT) (36.3%) and chemotherapy±ADT (26.2%). Compared with NH White pts, NH Black pts were younger (54.3% ≥ 75 years vs 27.7%), more likely to reside in the lowest SES areas (10.6% vs 27.7%), had a higher median prostate-specific antigen (PSA) levels at metastatic dx (36.3 vs 154.5 ng/mL) and were more likely to receive chemotherapy±ADT than ARPI±ADT in 1L mCRPC (25.0% vs 32.5%). Similarly, pts in the lowest SES quintile were younger (41.1% ≥ 75 years vs 52.0%) and more frequently treated with chemotherapy±ADT than those in the highest quintile (30.5% vs 26.4%).
CONCLUSIONS: This study demonstrates clinically meaningful heterogeneity in 1L mCRPC tx selection and ARPI reuse across racial/ethnic groups and area-level SES. These findings underscore the need to better understand how social determinants of health influence tx decision-making and access to therapies in mCRPC, and to inform strategies aimed at reducing inequities in care delivery.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD15
Topic
Health Service Delivery & Process of Care
Disease
Oncology, Personalized & Precision Medicine