ObjectiveTo conduct a systematic literature review of real‐world data (RWD) studies to summarise treatment patterns among men with metastatic hormone‐sensitive prostate cancer (mHSPC). While androgen‐deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade.MethodsWe searched electronic databases (PubMed; Excerpta Medica dataBASE [EMBASE]) for eligible studies (retrospective or prospective observational RWD studies examining mHSPC treatment patterns) between database inception and July 2023, and manually screened the past 2 years of relevant conference proceedings.ResultsOf 2336 retrieved citations, 29 studies met the inclusion criteria, covering North America (United States, n = 21; Canada, n = 2), Europe (n = 8), and Asia (n = 6). Most studies utilised retrospective cohorts (n = 26) and included men with a median age of ≥70 years (n = 20). ADT monotherapy was predominantly used across geographies, followed by ADT + ARPI and ADT + docetaxel in the United States and Europe but not in Asia, where use of each combination remained low. Studies with recent electronic medical record data from cancer centres/registries showed >40% use of ADT + ARPI in the United States and Europe. Abiraterone was the most frequently used ARPI, followed by enzalutamide. Quantitative factors associated with ADT intensification were high disease burden, younger age, Eastern Cooperative Oncology Group performance status score of 0 to 1, fewer comorbidities, and oncologist physician specialty; qualitative factors were patient preference, unsatisfactory response to ADT, ability to tolerate adverse events, and absence of cost barriers.ConclusionWhile there was an increasing trend in ADT intensification for mHSPC over the study period across geographies, use remained suboptimal considering the high proportion of patients who were still receiving ADT monotherapy only. These findings highlight the need for interventions to further optimise current mHSPC therapies with high guideline concordance.

中文翻译：

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强化雄激素剥夺疗法对转移性激素敏感性前列腺癌的实际应用：系统评价


目的对真实世界数据 （RWD） 研究进行系统的文献综述，以总结男性转移性激素敏感性前列腺癌 （mHSPC） 的治疗模式。虽然雄激素剥夺疗法 （ADT） 是 mHSPC 的主要治疗策略，但当前指南推荐使用雄激素受体途径抑制剂 （ARPI） 和/或化疗强化 ADT，并在过去十年中改善了临床结果。方法我们检索了电子数据库（PubMed;Excerpta Medica dataBASE [EMBASE]），用于数据库建立至 2023 年 7 月期间符合条件的研究（检查 mHSPC 治疗模式的回顾性或前瞻性观察性 RWD 研究），并手动筛选了过去 2 年的相关会议论文集。结果在检索到的 2336 篇引文中，29 项研究符合纳入标准，涵盖北美（美国，n = 21;加拿大 （n = 2）、欧洲 （n = 8） 和亚洲 （n = 6）。大多数研究使用回顾性队列 （n = 26），并纳入中位年龄为 ≥70 岁的男性 （n = 20）。ADT 单药治疗主要在各个地区使用，其次是美国和欧洲的 ADT + ARPI 和 ADT + 多西他赛，但在亚洲则没有，因为每种组合的使用率仍然很低。来自癌症中心/登记处的最新电子病历数据的研究显示，在美国和欧洲，ADT + ARPI 的使用率为 >40%。阿比特龙是最常用的 ARPI，其次是恩杂鲁胺。 与 ADT 强化相关的定量因素是疾病负担高、年龄较小、Eastern Cooperative Oncology Group 体能状态评分为 0 至 1、合并症较少和肿瘤科医生专业;定性因素是患者偏好、对 ADT 的反应不满意、耐受不良事件的能力以及没有成本障碍。结论虽然在研究期间，不同地区 mHSPC 的 ADT 强化呈增加趋势，但考虑到仍仅接受 ADT 单一治疗的患者比例很高，使用仍然不理想。这些发现强调了干预措施的必要性，以进一步优化当前的 mHSPC 疗法，具有高度的指南一致性。