Survival may be improving in de novo mHSPC, new data suggest

Data recently published in JAMA Network Open suggest that overall survival (OS) among patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC) has significantly improved in clinical practice in the United States from 2000 to 2019, potentially due to the increased use of combination therapy.¹

However, the authors also note that this study was observational in nature, so causality cannot be determined.

“In the last 10 years, several new therapies have been created that have made a dramatic impact in clinical trials. We wanted to study this in the general population to assess whether these breakthroughs were making its way to them,” said lead author Martin Schoen, MD, in a news release on the findings.² Schoen is an assistant professor of medicine and a member of the AHEAD Institute at Saint Louis University in St. Louis, Missouri.

In total, the cross-sectional study included data from 58,859 patients who were identified from the Surveillance, Epidemiology, and End Results (SEER) database and 14,904 patients who were identified from the Veterans Health Administration (VHA) database. All patients received a diagnosis of prostate cancer with distant metastasis from 2000 to 2019.

Data from SEER showed a median OS of 23.0 months between the years 2000 to 2004 in patients with mHSPC, which increased to 30.0 months between 2015 to 2019 (HR, 0.80; 95% CI, 0.77-0.82). Similarly, the median OS improved from 25.6 months to 30.9 months in the VHA during the same time periods (HR, 0.91; 95% CI, 0.87-0.96).

In patients aged younger than 70 years, the median OS in SEER was 31.0 months from 2000 to 2004 compared with 40.0 months from 2015 to 2019 (HR, 0.78; 95% CI, 0.74-0.82). The same trend was again seen among patients in the VHA who were aged younger than 70 years, with an increase from 34.3 months between 2000 to 2004 to 42.2 months from 2015 to 2019 (HR, 0.87; 95% CI, 0.80-0.95).

The increases observed among patients aged 70 or older were less significant. In SEER, the median OS increased from 19.0 months in 2000 to 2004 to 24.0 months between 2015 to 2019 (HR, 0.83; 95% CI, 0.80-0.86). In the VHA, the median OS was 21.6 months and 25.6 months for these time points, respectively (HR, 0.94; 95% CI, 0.88-1.00).

The authors wrote, “The improvements in OS mirror those observed in other countries and are likely due to the increased use of combination therapy. Our results suggest that new treatment paradigms may contribute to longer OS in clinical practice, which is the ideal setting to measure improvements in outcomes as treatments change.”¹

However, the investigators also emphasized the need for a better understanding of the adverse events associated with therapies for mHSPC in older adults given the lagging improvements in OS seen among these patients.

They wrote, “Older patients with comorbid disease may not benefit from new therapies and may have higher risk of adverse events. Tailoring treatment for mHSPC based on comorbidities or genetic features may improve patient outcomes.”¹

However, the authors also note that this study was limited by its lack of comorbidity data and that it was observational in nature, so causality cannot be determined.

References

1. Schoen MW, Montgomery RB, Owens L, Khan S, Sanfilippo KM, Etzioni RB. Survival in patients with de novo metastatic prostate cancer. JAMA Netw Open. 2024;7(3):e241970. doi:10.1001/jamanetworkopen.2024.1970

2. SLU researcher reports improvements in survival rates in patients with metastatic prostate cancer. News release. Saint Louis University. June 20, 2024. Accessed June 21, 2024. https://www.newswise.com/articles/slu-researcher-reports-improvements-in-survival-rates-in-patients-with-metastatic-prostate-cancer