TOPLINE:

Among patients with metastatic castration-resistant prostate cancer harboring BRCA1/2 alterations, nearly half (48.8%) did not receive a PARP inhibitor, despite recent FDA approvals and recent trials demonstrating a survival benefit associated with these agents in this patient population.

METHODOLOGY:

• The FDA has approved several PARP inhibitors for patients with metastatic castration-resistant prostate cancer who have BRCA1/2 alterations, after recent trials demonstrated that these agents can improve survival. However, real-world data on the use of PARP inhibitors in this patient population remain unclear.
• To assess uptake of these drugs, researchers conducted a retrospective cohort study using US electronic health record data from about 280 cancer clinics across the country.
• The cohort included 443 patients with metastatic castration-resistant prostate cancer harboring BRCA1/2 alterations who were alive after August 15, 2020 (shortly following the first PARP inhibitor approvals for this patient population). The data cutoff date was May 31, 2024.
• Researchers assessed the overall use of PARP inhibitors in this patient population as well as associations between patient characteristics — age, race and ethnicity, insurance status, and practice type — and use of PARP inhibitors. Patients were a median age of 72 years; most patients were White (61.6%), 11.7% were Black, 4.5% were Hispanic, and 2.3% were Asian (with 7.9% listed as other and 12.0% as unknown).

TAKEAWAY:

• Overall, 51.2% received a PARP inhibitor and 48.8% did not. Among recipients, 73.1% received monotherapy, 17.6% had combination therapy with an androgen receptor pathway inhibitor, and 9.3% received combination therapy with other agents.
• Patients covered by Medicare or other government programs had a significantly higher likelihood of receiving a PARP inhibitor than those with commercial health plans (odds ratio [OR], 1.91; P = .047).
• Black patients had lower odds of receiving a PARP inhibitor than White patients, although this difference did not reach statistical significance (OR, 0.57; P = .07). Compared to White patients, Asian patients had higher odds of receiving a PARP inhibitor, though this also did not reach statistical significance (OR, 7.04; P = .07).
• No significant association between receipt of PARP inhibitors and age or practice type was observed. For instance, patients treated in community centers were not significantly more likely to receive a PARP inhibitor than those treated in academic practices (OR, 1.64; 95% CI, 1.00-2.70).

IN PRACTICE:

"These findings highlight the need to increase awareness of the survival data and access to life-prolonging therapies in patients with metastatic castration-resistant prostate cancer," the study authors wrote. 

Charles L. Bennett, MD, PhD, and June M. McKoy, MD of the University of South Carolina College of Pharmacy, Columbia, highlighted "important implications and important limitations" of the study in an accompanying editorial.

"The study provides first-hand support of the power of large electronic databases to rapidly evaluate diffusion of new technologies," Bennett and McKoy wrote. However, the "study does not include explicit cost information." 

This lack of cost information led the editorialists to wonder: "Given that some are not considered to have National Comprehensive Cancer Network (NCCN) grade 1 evidence, how often is reimbursement not given specifically because of the lower level of NCCN evidence?" 

SOURCE:

The study, led by Micah Ostrowski, MD, Huntsman Cancer Institute, University of Utah in Salt Lake City, was published online in JAMA Network Open, alongside an editorial.

LIMITATIONS:

The retrospective design of the study, potential undocumented next-generation sequencing testing, and unaccounted confounding factors might have affected the findings. Additionally, important clinical variables that could affect treatment decisions — such as comorbidity, performance status, drug interactions, and patient preference — were not captured. The editorialists also note that, given the FDA approval timeline, it would be important to assess the timeline of therapy diffusion by individual PARP inhibitor.

DISCLOSURES:

The authors did not disclose any funding information. Several authors reported receiving research grants or personal fees and having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.