Real World Hospitalizations in US Veterans Treated for Metastatic Prostate Cancer with Combination Therapy

Area of Science:

• Oncology
• Pharmacology
• Health Services Research

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPC) treatment often involves androgen deprivation therapy (ADT) with docetaxel or an androgen receptor pathway inhibitor (ARPI).
• Comparative real-world data on hospitalization rates and adverse events (AEs) for these combination therapies are lacking.

Purpose of the Study:

• To compare real-world hospitalization rates and AEs between ADT+docetaxel and ADT+ARPI in mHSPC patients.
• To identify specific risks associated with each treatment regimen to guide clinical decision-making.

Main Methods:

• A retrospective nationwide study of 1549 US veterans (2013-2021) comparing ADT+docetaxel (n=500) vs. ADT+ARPI (n=1049).
• Hospitalizations were analyzed one year before and after treatment initiation.
• Baseline characteristics and incidence rate differences of AEs were compared.

Main Results:

• Hospitalizations increased significantly post-treatment for both groups: 245% for ADT+docetaxel and 125% for ADT+ARPI.
• The ADT+docetaxel group experienced higher rates of digestive and respiratory complication hospitalizations.
• The ADT+ARPI group showed increased hospitalizations for respiratory, endocrine/metabolic, and circulatory complications, but a decrease in acute renal failure admissions.

Conclusions:

• ADT+docetaxel and ADT+ARPI regimens present distinct hospitalization risks and AEs in real-world mHSPC treatment.
• Patients with respiratory/GI comorbidities may face higher risks with docetaxel.
• Older, frailer patients susceptible to infections/metabolic issues may be at increased risk with ARPIs, informing individualized therapy selection.