OBJECTIVES: Use contemporary real-world data (RWD) to analyze whether mHSPC patients and especially those newly initiating treatment are receiving doublet or triple therapy treatment intensification per guideline recommendations.

METHODS: This cross-sectional retrospective study included US mHSPC patients from the Ipsos Global Oncology Monitor, comprising data abstracted from patient charts and provided online by treating physicians. Data was descriptively analyzed for treatment utilization rates as moving quarterly totals from January 2021 to June 2023 with focus on latest quarter for all (N=575) and new (n=70) mHSPC patients.

RESULTS: Androgen deprivation therapy (ADT) as monotherapy (mADT) has moderated over time to 32.9% among the most recent patient cohort, while doublet therapy with novel androgen receptor inhibitor (nARI) + ADT has increased to become a leading treatment (39.9%). Use of abiraterone + ADT (14.3%), first-generation androgen receptor inhibitor (FGARI) + ADT (6.2%), and chemohormonal triple therapy (1.9%) also increased while use of docetaxel + ADT (1.6%) decreased. Treatment patterns among new versus all mHSPC patients showed greater dispersion, but similar trends away from mADT (34.7%) and docetaxel + ADT (0.7%) towards treatment intensification with nARI doublet (17.8%) and triple therapy (14.8%), notably with the combination of darolutamide + ADT + docetaxel (11.2%). Among all and new mHSPC patients, darolutamide triple therapy predominated over abiraterone triple therapy (1.6% vs 0.3%, 11.2% vs 3.6% respectively).

CONCLUSIONS: At 3 years post guideline update on treatment intensification for mHSPC, RWD shows residual non-concordance versus guidelines primarily as mADT, but also latest trends suggesting a narrowing of the gap in the observed increase of treatment intensification with utilization of guideline-recommended nARI doublet and triple therapy regimens, especially among new patient treatment initiations. Continued assessments are important to ensure real-world mHSPC patients are receiving optimized, clinical care.