Treatment Patterns and Attrition in Metastatic Castration-Resistant Prostate Cancer

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.