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Published on: March 6, 2018
Mortality in Medicare-aged Men With Metastatic Prostate Cancer After the Introduction of Androgen Receptor Pathway
Isaac E Kim1, Rebecca Hartman2, Krupa Gandhi2
1Department of Urology, Stanford University, Palo Alto, CA.
Objective:
To examine mortality and usage changes after the introduction of androgen receptor pathway inhibitors (ARPI) among older patients with metastatic prostate cancer covered by Medicare.
Materials And Methods:
The study cohort, consisting of patients newly diagnosed with mPCa, was identified from the surveillance, epidemiology, and end results (SEER)-Medicare Linked Database. The primary outcome was all-cause mortality with time zero at the date of mPCa diagnosis. Patients were classified as pre-ARPI era if diagnosed with mPCa in 2006-2012 and ARPI era if diagnosed in 2013-2019. Mortality was summarized by unadjusted cumulative incidence and evaluated using covariate adjusted mortality hazard ratios (aHRs) from Cox proportional hazards regression modeling.
Results:
This study included 9625 patients diagnosed with mPCa (median age 78 years). 44.3% of patients with Medicaid Part D coverage were prescribed therapies in the ARPI era. Stratification by stage revealed that patients with M1a and M1b disease experienced significantly decreased mortality (aHRs: M1a 0.77, 95% CI 0.60-0.98, P = .03; M1b 0.81, 0.77-0.86, P <.01; M1c 0.90, 0.80-1.01; P = .06).
Conclusions:
Since the introduction of ARPIs, the uptake among Medicare patients was relatively high. While we observed a significant 20% lower mortality hazard among patients diagnosed with mPCa after 2013 when ARPIs were introduced, some of the improvement might have resulted from stage migration.
Insights
Androgen receptor pathway inhibitors (ARPIs) showed high uptake in Medicare patients with metastatic prostate cancer. ARPI introduction correlated with a significant 20% reduction in mortality hazard, though stage migration may also contribute to improvements.
Area of Science:
- Oncology
- Geriatric Medicine
- Health Services Research
Background:
- Metastatic prostate cancer (mPCa) significantly impacts older adults.
- Androgen receptor pathway inhibitors (ARPIs) represent a key therapeutic advance.
- Understanding ARPI impact in real-world Medicare populations is crucial.
Purpose of the Study:
- To evaluate mortality trends and medication usage post-ARPI introduction in older Medicare beneficiaries with mPCa.
- To assess the association between ARPI era diagnosis and all-cause mortality.
Main Methods:
- Cohort identification from the SEER-Medicare Linked Database for newly diagnosed mPCa patients.
- Classification into pre-ARPI (2006-2012) and ARPI (2013-2019) eras.
- Mortality analysis using cumulative incidence and Cox proportional hazards regression for adjusted hazard ratios (aHRs).
Main Results:
- Included 9,625 mPCa patients (median age 78); 44.3% received ARPIs in the ARPI era.
- Significantly decreased mortality observed for M1a (aHR: 0.77) and M1b (aHR: 0.81) disease stages.
- A trend towards decreased mortality was noted for M1c disease (aHR: 0.90).
Conclusions:
- ARPIs demonstrated substantial uptake among Medicare patients with mPCa.
- A significant 20% reduction in mortality hazard was associated with the ARPI era.
- Potential influence of stage migration on observed mortality improvements warrants further investigation.
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