Purpose: Some new agents recently approved for treatment of metastatic castrate-resistant prostate cancer (mCRPC) have been associated with adverse events affecting patients with central nervous system (CNS) comorbidities. This has stimulated stakeholder interest in CNS comorbidities for this population. Since patterns of such comorbidities have not been described yet in a real-world setting, this research aims to evaluate the proportion of patients with mCRPC who suffer from selected CNS comorbidities.
Methods: Medical claims from two commercially available datasets were used to identify treatment patterns in adult mCRPC patients (≥2 PC diagnosis codes, ≥1 metastasis diagnoses, prior luteinizing-hormone- releasing hormone [LHRH] agonist or surgical castration, no other cancer diagnosis). CRPC treatment was defined as chemotherapy, antiandrogen initiation after 90 days of LHRH start date, adrenal androgen blocker, or estrogen. The mCRPC index date was defined as either the first CRPC treatment initiation date or the date of the first metastasis diagnosis, whichever occurred later. The observation period spanned from the index date to the end of health insurance eligibility. The proportion of patients with selected CNS comorbidities (listed below) during the observation period was evaluated; however, the latter three conditions were not analyzed for dataset 1.
Results: Analyses of both datasets reported that bone and lymph nodes were the predominant metastatic sites in mCRPC patients. Bicalutamide was the most common secondary hormonal therapy and docetaxel was the most common chemotherapy. The following table presents the mean age at index date and the proportion of mCRPC patients with selected CNS comorbidities during the observation period.
| Dataset 1 (n=2,593) | Dataset 2 (n=626) |
Mean age, years | 73 | 68 |
Median observation period, days | 403 | 347 |
Seizures | 3.1% | 5.5% |
Head trauma | 5.9% | 4.3% |
CNS tumor | 1.0% | 1.4% |
Transient ischemic attack | NA | 3.1% |
Neoplasm of the brain or spinal cord | NA | 8.4% |
Stroke | NA | 13.2% |
NA-Not available
Conclusion: This descriptive report identified CNS comorbidities in a subset of patients with mCRPC. Such findings may support health care providers and patients considering treatment decisions. Further real-world research is warranted regarding a wider list of CNS conditions and the impact of the new treatments on these conditions in this patient population.