TY - JOUR
T1 - Systematic Review of Efficacy and Health Economic Implications of Real-world Treatment Sequencing in Prostate Cancer
T2 - Where Do the Newer Agents Enzalutamide and Abiraterone Fit in?
AU - Pereira-Salgado, Amanda
AU - Kwan, Edmond Michael
AU - Tran, Ben
AU - Gibbs, Peter
AU - De Bono, Johann
AU - IJzerman, Maarten
N1 - Funding Information:
We acknowledge the International AIDS Vaccine Initiative (IAVI) and the U.S. Agency for International Development (USAID) for support and funding of the IAVI cohort. This work was supported by NIH grants RO1 A1 084772 (P.A.G.), RO1 A1 112566 (P.A.G.), R56 A1 098551 (P.A.G.), and RO1 A1 064060 (P.A.G. and E.H.), by Center for HIV/AIDS Vaccine Immunology grant A1 067854 (A.J.M.), and by the Grand Challenges in Global Health Program of the Bill and Melinda Gates Foundation, under grant 37874 (P.B.). Parts of the work were performed in the UAB CFAR BSL-3 facilities and by the UAB CFAR Flow Cytometry Core/Joint UAB Flow Cytometry Core, which are funded by NIH/NIAID grant P30 AI027767 and NIH grant 5P30 AR048311.
Publisher Copyright:
© 2020 European Association of Urology
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Context: Optimal treatment sequencing of abiraterone and enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) is challenging. Real-world data (RWD) allow a better understanding of health economic implications in the real world. Objective: To determine survival and cost outcomes for two real-world treatment sequences, comparing abiraterone to enzalutamide (AA → ENZ) with enzalutamide to abiraterone (ENZ → AA). Evidence acquisition: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed in Medline, Embase, and Web of Science. Evidence synthesis: Seventeen studies met our inclusion criteria. Of studies with survival outcomes, 10 featured AA → ENZ treatment sequences (n = 575), four ENZ → AA sequences (n = 205), and three both sequences. Better survival outcomes were demonstrated in the AA → ENZ cohorts in several studies reporting prostate-specific antigen (PSA) progression-free survival (PSA-PFS), combined PSA-PFS, and PSA decline ≥50%. Three studies showed shorter treatment duration in cohorts receiving second-line enzalutamide compared with abiraterone. Collectively, six RWD costing studies described patients with mCRPC who experienced treatment with enzalutamide (n = 4195), abiraterone (n = 10 372), AA → ENZ (n = 443), and ENZ → AA (n = 91). No study estimated the cost of treatment sequencing of AA → ENZ or ENZ → AA. Conclusions: No head-to-head studies were found, but we hypothesise that the AA → ENZ sequence may be less costly than ENZ → AA, because time on treatment tends to be longer for a first-line treatment and abiraterone is less costly than enzalutamide. There are indications that overall survival of AA → ENZ is superior to that of ENZ → AA, which supports the former sequence as more cost effective. Patient summary: Better survival outcomes were reported in several studies where patients with advanced prostate cancer received the abiraterone to enzalutamide sequence compared with the enzalutamide to abiraterone sequence. No study estimated the cost of sequencing either treatment approach.
AB - Context: Optimal treatment sequencing of abiraterone and enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) is challenging. Real-world data (RWD) allow a better understanding of health economic implications in the real world. Objective: To determine survival and cost outcomes for two real-world treatment sequences, comparing abiraterone to enzalutamide (AA → ENZ) with enzalutamide to abiraterone (ENZ → AA). Evidence acquisition: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed in Medline, Embase, and Web of Science. Evidence synthesis: Seventeen studies met our inclusion criteria. Of studies with survival outcomes, 10 featured AA → ENZ treatment sequences (n = 575), four ENZ → AA sequences (n = 205), and three both sequences. Better survival outcomes were demonstrated in the AA → ENZ cohorts in several studies reporting prostate-specific antigen (PSA) progression-free survival (PSA-PFS), combined PSA-PFS, and PSA decline ≥50%. Three studies showed shorter treatment duration in cohorts receiving second-line enzalutamide compared with abiraterone. Collectively, six RWD costing studies described patients with mCRPC who experienced treatment with enzalutamide (n = 4195), abiraterone (n = 10 372), AA → ENZ (n = 443), and ENZ → AA (n = 91). No study estimated the cost of treatment sequencing of AA → ENZ or ENZ → AA. Conclusions: No head-to-head studies were found, but we hypothesise that the AA → ENZ sequence may be less costly than ENZ → AA, because time on treatment tends to be longer for a first-line treatment and abiraterone is less costly than enzalutamide. There are indications that overall survival of AA → ENZ is superior to that of ENZ → AA, which supports the former sequence as more cost effective. Patient summary: Better survival outcomes were reported in several studies where patients with advanced prostate cancer received the abiraterone to enzalutamide sequence compared with the enzalutamide to abiraterone sequence. No study estimated the cost of sequencing either treatment approach.
KW - Abiraterone
KW - Castration resistant
KW - Enzalutamide
KW - Health economics
KW - Prostate cancer
KW - Treatment sequence
UR - http://www.scopus.com/inward/record.url?scp=85082760209&partnerID=8YFLogxK
U2 - 10.1016/j.euf.2020.03.003
DO - 10.1016/j.euf.2020.03.003
M3 - Review Article
C2 - 32273196
AN - SCOPUS:85082760209
SN - 2405-4569
VL - 7
SP - 752
EP - 763
JO - European Urology Focus
JF - European Urology Focus
IS - 4
ER -
