Comparative analysis of real-world data of frequent treatment sequences in metastatic prostate cancer

Abstract

Background: The incidence of prostate cancer is increasing worldwide. A significant proportion of patients develop metastatic disease and are initially prescribed androgen deprivation therapy (ADT). However, subsequent sequences of treatments in real-world settings that may improve overall survival remain an area of active investigation.

Materials and methods: Data were collected from 384 patients presenting with de novo metastatic prostate cancer from 2011 to 2015 at a tertiary cancer center. Patients were categorized into surviving (n = 232) and deceased (n = 152) groups at the end of 3 years. Modified sequence pattern mining techniques (Generalized Sequential Pattern Mining and Sequential Pattern Discovery using Equivalence Classes) were applied to determine the exact order of the most frequent sets of treatments in each group.

Results: Degarelix, as the initial form of ADT, was uniquely in the surviving group. The sequence of ADT followed by abiraterone and docetaxel was uniquely associated with a higher 3-year overall survival. Orchiectomy followed by fosfestrol was found to have a unique niche among surviving patients with a long duration of response to the initial ADT. Patients who received chemotherapy followed by radiotherapy and those who received radiotherapy followed by chemotherapy were found more frequently in the deceased group.

Conclusions: We identified unique treatment sequences among surviving and deceased patients at the end of 3 years. Degarelix should be the preferred form of ADT. Patients who received ADT followed by abiraterone and chemotherapy showed better results. Patients requiring palliative radiation and chemotherapy in any sequence were significantly more frequent in the deceased group, identifying the need to offer such patients the most efficacious agents and to target them in clinical trial design.

Keywords

Hormone therapy / Metastatic prostate cancer / Sequence mining / Survival

Author summay

Jiten Jaipuria and Ishleen Kaur contributed equally.

Supplemental Digital Content is available for this article.

Acknowledgments

The authors thank the data entry operators of the Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, for handling computerized records.

Statement of ethics

Ethical approval was granted by the institutional review board of the Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India (Res/SCM/43/2020/119). Data were collected in accordance with the hospital policies. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Because of the retrospective nature of study and the use of anonymized records, need to obtain informed consent from study participants was waived off.

Conflict of interest statement

No conflict of interest has been declared by the author.

Funding source

None.

Author contributions

JJ: Participated in research design, writing of the paper, data analysis;

IK: Participated in research design, writing of the paper, contributed new analytic tools, data analysis;

MND: Contributed new reagents or analytic tools, performance of the research;

TA: Participated in performance of the research;

AS, SKR, VT, GS: Participated in research design.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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