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Treatment Patterns and Attrition in Metastatic Castration-Resistant Prostate Cancer.

Gabriel Hooper1, Yeonjung Jo1, Varun Nandakumar1

  • 1Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City.

JAMA Network Open
|June 29, 2026
PubMed
Summary
This summary is machine-generated.

Metastatic castration-resistant prostate cancer (mCRPC) treatment shows significant patient drop-off after second-line therapy. Androgen receptor pathway inhibitors (ARPIs) and taxanes are common early treatments, with lutetium Lu 177-prostate-specific membrane antigen 617 (Lu-177) and poly (adenosine diphosphate-ribose) polymerase inhibitors (PARPIs) used later.

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Sequencing Small Non-coding RNA from Formalin-fixed Tissues and Serum-derived Exosomes from Castration-resistant Prostate Cancer Patients
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Sequencing Small Non-coding RNA from Formalin-fixed Tissues and Serum-derived Exosomes from Castration-resistant Prostate Cancer Patients

Published on: November 19, 2019

Area of Science:

  • Oncology
  • Medical treatment patterns

Background:

  • The therapeutic options for metastatic castration-resistant prostate cancer (mCRPC) are rapidly expanding, leading to complex treatment decisions.
  • There is a lack of recent, large-scale studies on mCRPC treatment patterns and patient attrition in clinical practice.

Purpose of the Study:

  • To analyze treatment patterns and attrition rates among patients with mCRPC between 2021 and 2025.

Main Methods:

  • A retrospective analysis of a US-based electronic health record database (Flatiron Health Research Database) was conducted.
  • The study included patients with mCRPC who started first-line therapy from January 1, 2021, to June 30, 2025, across approximately 280 community oncology practices.
  • Treatment patterns and attrition were evaluated across first through fifth-line therapies, categorizing treatments including androgen receptor pathway inhibitors (ARPIs), taxanes, poly (adenosine diphosphate-ribose) polymerase inhibitors (PARPIs), and lutetium Lu 177-prostate-specific membrane antigen 617 (Lu-177).

Main Results:

  • The analysis included 5096 patients with mCRPC. Only 53.6% received second-line and 26.2% received third-line treatment, indicating significant attrition.
  • Androgen receptor pathway inhibitors (ARPIs) were the most frequent first- and second-line treatments (79.3% and 41.1%, respectively).
  • Taxane use increased across lines, becoming the most common third-line treatment (36.4%). Lutetium Lu 177-prostate-specific membrane antigen 617 (Lu-177) use increased progressively in later lines (2.2% first-line to 31.4% fifth-line). Poly (adenosine diphosphate-ribose) polymerase inhibitors (PARPIs) showed limited use.

Conclusions:

  • Treatment attrition is substantial in mCRPC, with over half of patients not reaching second-line therapy.
  • ARPIs and taxanes remain primary treatments, while Lu-177 and PARPIs are increasingly used in later treatment stages.
  • The findings emphasize the need for optimized sequencing strategies, improved frontline therapies, and interventions to enhance treatment access for mCRPC patients.