Real-World Data Suggests Improved Outcomes with Dual Therapy in Metastatic Hormone-Sensitive Prostate Cancer

Strategic Insights -

A new study published in European Urology Oncology has shed light on the treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC). The researchers aimed to describe treatment trajectories and clinical outcomes in a large, multicenter real-world data (RWD) cohort under the PIONEER project. The study analyzed data from eight European and US databases, including electronic health records, insurance claims, primary care data, and cancer registries, and identified 107,438 patients with mHSPC and 67,909 who received treatment.

Key Takeaways:

  • The majority of patients received androgen deprivation therapy (ADT) monotherapy, but the use of ADT + an androgen receptor pathway inhibitor (ARPI) increased over time.
  • ADT + ARPI showed the highest persistence (53.8%) and a 5-yr switch-free survival rate of up to 72.3%.
  • ADT monotherapy had 5-yr switch-free survival rates of 21.3-58.6% and adverse event-free survival rates of 64.7-81.2%.
  • Addition of an ARPI improved switch-free survival (24.1-72.3%) but lowered adverse event-free survival (55.2-82.7%).
  • Chemotherapy-based and triplet therapies showed variable results without consistent survival benefit.
  • The study's limitations include residual confounding, inconsistent adverse event reporting, and possible data overlap.
  • This is the largest RWD study of systemic mHSPC treatment, and ADT monotherapy remains the most used first-line therapy despite evidence suggesting improved outcomes with dual therapy.

Statistics:

  • 107,438 patients with mHSPC were identified in the study.
  • 67,909 patients with mHSPC received treatment.
  • 69.4% of patients received ADT monotherapy.
  • 15.2% of patients received ADT + ARPI.
  • 14.0% of patients received ADT + chemotherapy.
  • 1.2% of patients received triplet therapy.
  • The study showed a 5-yr switch-free survival rate of up to 72.3% with ADT + ARPI.
  • The study showed an adverse event-free survival rate of 64.7-81.2% with ADT monotherapy.

Sources:

  • "Treatment Trajectories in Metastatic Hormone-sensitive Prostate Cancer: A PIONEER+ Big Data Analysis" - European Urology Oncology, 2025
  • University of Florence
  • Department of Experimental and Clinical Biomedical Science, University of Florence
  • European Urology Oncology, Elsevier
  • Radarweg 29, 1043 Nx Amsterdam, Netherlands