Treatment Trajectories in Metastatic Hormone-sensitive Prostate Cancer: A PIONEER+ Big Data Analysis

Area of Science:

• Oncology
• Real-world evidence
• Prostate cancer research

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPC) treatment is rapidly evolving.
• Real-world data (RWD) are crucial for understanding actual treatment patterns and outcomes.
• The PIONEER project leverages large-scale RWD to analyze mHSPC treatment trajectories.

Purpose of the Study:

• To describe treatment patterns and clinical outcomes in a large, multicenter mHSPC cohort using RWD.
• To analyze treatment switch, progression, adverse events, and survival in mHSPC patients.
• To evaluate the real-world effectiveness of different mHSPC treatment strategies.

Main Methods:

• Utilized eight European and US databases (2016-2020) standardized to the Observational Medical Outcome Partnership Common Data Model.
• Identified patients diagnosed with mHSPC and those receiving treatment.
• Analyzed outcomes including treatment switch, symptomatic progression, adverse events, and death.

Main Results:

• Over 107,000 mHSPC patients identified; 67,909 received treatment.
• Androgen deprivation therapy (ADT) monotherapy was most common (69.4%), followed by ADT + androgen receptor pathway inhibitor (ARPI; 15.2%).
• ADT + ARPI demonstrated higher persistence (53.8%) and improved 5-year switch-free survival (up to 72.3%) compared to ADT monotherapy.

Conclusions:

• This is the largest RWD study on systemic mHSPC treatment.
• ADT monotherapy remains the most frequent first-line therapy despite evidence supporting other options.
• Increased use of ADT + ARPI is linked to better persistence and outcomes, supporting its wider clinical adoption.