Computer modelling in prostate anticancer therapy (COMPACT).

Abstract

Background: Prostate cancer is the most common solid malignancy in men and despite improving radical therapies a proportion of patients will develop castrate resistant metastatic disease (mCRPC). Therapeutic options in mCRPC include abiraterone acetate and prednisolone (AA+P), enzalutamide (E) and docetaxel (D) with limited evidence to guide clinical choice between agents. COMPACT aims to collate data from multiple data sets within one hospital to assess clinical or biochemical factors that may guide therapeutic strategy. Methods: Data was collated on all patients recorded as receiving therapy with AA+P, E or D in the metastatic castrate resistant setting from the chemotherapy prescribing and dispensing systems and the pathology system at University College Hospital, London. Individual clinical notes were reviewed to determine the reason for stopping therapies. Data was collated in one dataset and analysed to present baseline demographic data. The log-rank test was used to analyse differences in the retention rate among AA+P, E and D. Results: 598 individual treatments were identified in 441 patients. 172 patients received AA+P, 119 E and 307 D with a mean age at treatment initiation of 74.1, 76.8 and 69.5 years respectively. Of the 144 patients receiving two or more treatment lines, 62% (n = 89) received D prior to either AA+P or E. E was first line therapy in 18% (n = 26) and AA+P in 20% (n = 29). 5 (3.5%) patients transferred directly from AA+P to E and 12 (8%) from E to AA+P. Kaplan Meir estimates for time to retention show no statistically significant differences when directly comparing AA+P, E and D on univariate analysis with chi squared test (AA+P vs E = 0.3609, p = 0.558 D vs E = 0.365, p = 0.5457, D vs AA+P = 0.0136 p = 0.9072). Conclusions: The COMPACT study has confirmed that it is feasible for single institutions to retrospectively review real world data from different sources, combining it into a workable database. Patient numbers were sufficient to statistically analyse the data for specific clinical factors that may correlate to a prolonged biochemical response to AA+P, E or D therapy. The failure to detect a statistically significant difference between therapies on univariate analysis may confirm that all three are acceptable treatments in mCRPC.