Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE)

Authors

  • Jenny J. Ko Department of Medical Oncology, Abbotsford Cancer Centre, Abbotsford, BC, Canada
  • Lawrence Mbuagbaw Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Scott Tyldesley Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
  • Jennifer Lowther Medical Affairs, Bayer Inc., Mississauga, ON, Canada
  • Katherine Sunderland Division of Cancer Surveillance and Outcomes, BC Cancer, Vancouver, BC, Canada
  • Catherine Royer PeriPharm Inc., Montréal, QC, Canada
  • Mareva Faure PeriPharm Inc., Montréal, QC, Canada
  • Corin MacPhail Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
  • Shoaib Faizi Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC, Canada
  • Winson Y. Cheung Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
  • Richard Lee-Ying Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

DOI:

https://doi.org/10.5489/cuaj.8620

Keywords:

prostate cancer, radium-223, life-prolonging therapy, treatment sequencing

Abstract

Introduction: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces.

Methods: This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately.

Results: OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66–0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894–1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93–2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec.

Conclusions: Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence.

Downloads

Download data is not yet available.

Downloads

Published

2024-03-01

How to Cite

Ko, J. J., Mbuagbaw, L., Tyldesley, S., Lowther, J., Sunderland, K., Royer, C., Faure, M., MacPhail, C., Faizi, S., Cheung, W. Y., & Lee-Ying, R. (2024). Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE). Canadian Urological Association Journal, 18(7). https://doi.org/10.5489/cuaj.8620

Issue

Vol. 18 No. 7 (2024): CUAJ July

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.