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The study will be conducted from a real-world perspective to describe treatment sequences involving radium-223 and chemotherapy in patients with metastatic castrate resistant prostate cancer (mCRPC) and assess overall survival (OS) associated with treatment sequences involving radium-223 and chemotherapy. While clinical trials of radium-223 has demonstrated a survival benefit in the treatment of mCRPC, both pre and post- docetaxel, study lacked exposure to second generation androgens and hence could not assess outcomes pre or post abiraterone or enzalutamide.
The specific objective of this study is to describe and compare the clinical outcomes between treatment sequences for patients with mCRPC where 1) radium-223 is used (alone or in combination with abiraterone or enzalutamide) prior to chemotherapy versus 2) radium-223 used after chemotherapy in the treatment of mCRPC. The secondary objectives are to describe the safety patterns of docetaxel use among mCRPC patients who received chemotherapy post radium-223.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ra-223 therapy before chemotherapy | Treatment sequence 1 will include all mCRPC patients who received Ra-223 alone or in combination with abiraterone or enzalutamide and subsequently received chemotherapy |
| |
| Ra-223 after chemotherapy | Treatment sequence 2 includes all mCRPC patients who received chemotherapy before Radium 223 therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Xofigo | Drug | Radium-223, 55kBq (1.49 microcurie) per kg body weight given at 4 week intervals for 6 injection |
|
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | Survival will be measured from initiation of first line therapy after mCRPC diagnosis until the date of death (from any cause). | Up to 30 months |
| Time to symtomatic skeletal event(SSE) | Measured as the time from initiation of first-line therapy after mCRPC diagnosis until first SSE; for the exploratory analysis, measured as the time from initiation of radium-223 until first SSE. SSE will be identified based on the ALSYMPCA trial definition: first use of external-beam radiation therapy (EBRT) to relieve skeletal symptoms, new symptomatic pathologic vertebral or non-vertebral bone fractures, spinal cord compression, or tumor-related orthopedic surgical intervention | Up to 30 months |
| Reasons for treatment discontinuation | data for treatment discontinuation for each mCRPC therapy will be collected | Up to 30 months |
| Measure | Description | Time Frame |
|---|---|---|
| Laboratory-based outcomes collected by questionnaire | Data will be collected as available from initiation of docetaxel until 3 months following last dose of docetaxel | Up to 30 months |
| Treatments received |
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Inclusion Criteria:
Exclusion Criteria:
- No documented visceral metastasis at initiation of radium-223
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The study population will be comprised of patients with CRPC and bone metastasis who have received at least one dose of radium-223 at one of the participating cancer centers. The participating centers are 4 tertiary care cancer centers (Dana Farber Cancer Institute, Tulane Cancer Center, Memorial Sloan Kettering Cancer Center and Beth Israel Deaconess Medical Center)
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bayer US | Whippany | New Jersey | 07981 | United States |
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| ID | Term |
|---|---|
| D011471 | Prostatic Neoplasms |
| ID | Term |
|---|---|
| D005834 | Genital Neoplasms, Male |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| C581106 | radium Ra 223 dichloride |
| D000077143 | Docetaxel |
| C552428 | cabazitaxel |
| ID | Term |
|---|---|
| D043823 | Taxoids |
| D043822 | Cyclodecanes |
| D003516 | Cycloparaffins |
| D006840 | Hydrocarbons, Alicyclic |
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| Taxotere | Drug | Docetaxel injection 75mg/m2 every 3 weeks |
|
| Jevtana | Drug | Cabazitaxel injection 25mg/m2 intravenously once every 3 weeks |
|
measured as Yes/No
| Up to 30 months |
| Number of hospitalizations | along with the discharge diagnosis, as recorded in medical charts or discharge summaries | Up to 30 months |
| PSA PFS | defined as death or an increase above PSA nadir by ≥25% and ≥2 ng/mL (PCWG 2008 definition for Prostate specific antigen(PSA) Progression-free survival(PFS)) | Up to 30 months |
| Non-laboratory based clinically relevant safety outcomes | documented in medical records | Up to 30 months |
| hospital length of stay | Up to 30 months |
| D005832 |
| Genital Diseases, Male |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D011469 | Prostatic Diseases |
| D052801 | Male Urogenital Diseases |
| D006844 |
| Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D004224 | Diterpenes |
| D013729 | Terpenes |