1. Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE).
- Author
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Ko, Jenny J., Mbuagbaw, Lawrence, Tyldesley, Scott, Lowther, Jennifer, Sunderland, Katherine, Royer, Catherine, Faure, Mareva, MacPhail, Corin, Faizi, Shoaib, Cheung, Winson Y., and Lee-Ying, Richard
- Subjects
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HEALTH services accessibility , *MEDICAL care use , *CASTRATION-resistant prostate cancer , *RESEARCH funding , *TREATMENT effectiveness , *RADIUM , *RETROSPECTIVE studies , *CANCER patients , *POPULATION geography , *DESCRIPTIVE statistics , *METASTASIS , *LONGITUDINAL method , *MEDICAL records , *ACQUISITION of data , *RADIATION doses , *PROGRESSION-free survival , *CONFIDENCE intervals , *DISEASE progression , *OVERALL survival , *GENETICS , *EVALUATION , *SYMPTOMS - Abstract
INTRODUCTION: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces. METHODS: This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately. RESULTS: OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894-1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93-2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec. CONCLUSIONS: Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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