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Real-world use of bone modifying agents in metastatic, castration-resistant prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 126–132 (2023)Cite this article

Subjects

Abstract

Background

Bone modifying agents (BMAs) prevent skeletal related events among patients with metastatic, castration-resistant prostate cancer (mCRPC) involving bone and prevent osteoporotic fractures among patients at high risk. BMA utilization for patients with mCRPC has not been well quantified.

Methods

We used linked SEER registry and Medicare claims data. We included men diagnosed with stage IV prostate adenocarcinoma during 2007–2015, aged > = 66 at diagnosis, with sufficient continuous enrollment in Medicare Parts A, B, and D, who received androgen deprivation therapy. We limited to those who subsequently received a CRPC-defining treatment (CDT). We identified patients with evidence of bone metastasis using claims. Our primary outcome was receipt of a BMA (zoledronic acid or denosumab) within 180 days of initiating CDT.

Results

Among 1292 included patients, 1034 (80%) had bone metastasis. BMA use within 180 days of initiating CDT was higher among patients with bone metastases than those without (705/1034 [68%] vs 56/258 [22%]). Among patients without bone metastasis, those with high osteoporotic fracture risk were more likely than those without to receive a BMA (OR = 2.48, 95% CI: 1.17, 5.29); however, only 26% of patients with high fracture risk received a BMA. Among patients who received BMAs, most (62%) first initiated them >90 days before initiating CDT.

Conclusions

Two-thirds of patients with mCRPC and bone metastases received BMAs within 180 days after initiating CDT. A greater proportion of patients without bone metastasis may warrant BMA therapy for osteoporotic fracture prevention. Some patients with bone metastasis may be able to delay BMA initiation until CRPC.

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Fig. 1: Proportion of patients with bone metastasis who received a bone modifying agent within 180 days after initiating CRPC-defining treatment, over time.

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Data availability

The data underlying this article were provided by the Centers for Medicare and Medicaid Services (CMS) under license. Data are available from CMS on request and establishment of data use agreement.

Code availability

Code available in supplementary materials.

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Funding

This work was supported by the National Cancer Institute at the National Institutes of Health [grant numbers 1R03CA259863-01 to A.P.M, and P30CA008748]. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Aaron P. Mitchell, Akriti Mishra Meza, Katherine S. Panageas & Allison Lipitz-Snyderman

  2. Department of Medicine and Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Aaron P. Mitchell & Michael J. Morris

  3. Department of Medicine and Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Azeez Farooki

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Contributions

APM: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, visualization, writing-final draft, and writing- review and editing. AMM: data curation, formal analysis, investigation, methodology, resources, software, validation, visualization, and writing-review and editing. KSP: Data curation, formal analysis, investigation, methodology, and writing-review and editing. AS: conceptualization, investigation, methodology, and writing-review and editing. AF: conceptualization, investigation, and writing-review and editing. MM: conceptualization, supervision, and writing-review and editing. The final manuscript was approval by all authors. Dr. Mitchell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation: American Society of Clinical Oncology Genitourinary Symposium, 2022

Corresponding author

Correspondence to Aaron P. Mitchell.

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Competing interests

APM and AS have no potential conflicts of interest to disclose. AMM declares stock ownership in Johnson & Johnson, DNA, and Teladoc Health. KP declares stock ownership in T2 Biosystems, Adicet Bio, Inc., Chinook Therapeutics, Codexis, and Vincerx Pharma. AF declares consulting for Amgen. MM declares consulting and/or advisory arrangements with Bayer, Novartis, Advanced Accelerator Applications, ORIC Pharmaceuticals, Johnson & Johnson, Curium Pharma, Athenex, Exelixis, AstraZeneca, and Amgen, paid travel for Endocyte and Fujifilm, and research funding from Bayer, Sanofi, Endocyte, Progenics, Corcept Therapeutics, Roche/Genentech, and Janssen.

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Mitchell, A.P., Meza, A.M., Panageas, K.S. et al. Real-world use of bone modifying agents in metastatic, castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 26, 126–132 (2023). https://doi.org/10.1038/s41391-022-00573-y

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