A Study to Learn About Novel Hormonal Therapies (NHTs) for Metastatic Castration-sensitive Prostate Cancer (mCSPC) in People Who Were in the Armed Forces

Completed

Brief Summary: The purpose of this study is to learn about- for how long are NHTs taken by men to treat mCSPC. NHTs in this study include study medicines:

* abiraterone,

* apalutamide,

* enzalutamide.

Prostate cancer is one of the most common cancers in men. The prostate is a gland in the male body that helps make semen. Metastatic cancer is a cancer that has spread to other parts of the body. Most prostate cancers need male hormones to grow. When cancer cells respond to treatment that lowers male hormones, this is known as castration-sensitive prostate cancer.

This is a real-world study, not a clinical trial. This means that researchers will look at what happens when men receive the treatments prescribed by their own doctor as part of their usual healthcare treatment. In this study, researchers will use information from National Veteran's Affairs (VA) Health Care Network.

The study will include patients' information from the database for men who:

* were identified to have mCSPC.

* started treatment with NHT for mCSPC.

* were 18 years of age or older at start of NHT.

Men in this study will be taking NHT for treatment of their mCSPC. The study will explain:

* how long men take the therapy.

* how long it takes to start next therapy.

This study will use patient information about medications and treatments from VA data. This study will use information one year before start of NHT until information is available.

Recruitment & Eligibility

Inclusion Criteria

Male with ≥ 1 diagnosis claim for prostate cancer
Had documented secondary metastasis code on or after the initial prostate cancer diagnosis
Had initiated novel hormonal therapy (abiraterone, apalutamide, or enzalutamide) within 90 days prior to the metastasis date or on or after the metastasis date. The initiation date of the earliest novel hormonal therapy will be defined as the index date
≥18 years old on index date
Continuous enrollment for at least 365 days before index date
Evidence to be castration-sensitive:
- No prior surgical castration any time prior to the index date or no medical castration with ≥8 weeks of continuous use within -90 to -365 days prior to the index date, OR
- Diagnosis of hormone sensitive malignancy status within 90 days before the index date

Exclusion Criteria

Evidence of castration-resistance prior to the index date
- Received other prostate cancer treatment including NHT, non-steroidal anti-androgen (NSAA), chemotherapy, immunotherapy, radium 223, lutetium Lu 177 vipivotide tetraxetan, ketoconazole, or PARP inhibitor prior to the index date
- Had diagnosis code indicating hormone resistance prior to the index date
- A rise in prostate-specific antigen from the nadir by ≥2 ng/mL after castration
Had a prior history of other cancers (except non-melanoma skin cancer)
Participation in a clinical trial during the 30 days before the index date

Arm && Interventions

Group	Intervention	Description
Novel hormonal therapy cohort	Novel hormonal therapy	Patients initiating novel hormonal therapy (abiraterone, apalutamide or enzalutamide) for mCSPC

Primary Outcome Measures

Name	Time	Method
Duration of Therapy (DOT)	From start of index treatment to date of NHT discontinuation or censoring date, whichever came first, during maximum follow-up of 45 months	DOT was defined as the time from the index date to the date of NHT discontinuation for any reason. Discontinuation of the current NHT was defined as a treatment gap of at least 90 days (the last day with days' supply before the gap as discontinuation date), the initiation of a new therapy, or death, whichever came first. Initiation of a new therapy was defined by switching to a different NHT, switching to or augmentation with different therapies. Participants who did not experience discontinuation were censored at the end of data availability. Index date was defined as the initiation date of NHT in 1L (any date) from 1-January-2020 to 31-December-2022. Retrospective data was retrieved using the Veterans' Health Administration data for period of 01-Jan-2020 to 30-Sep-2023 (45 months).

Secondary Outcome Measures

Name	Time	Method
Time to Next Therapy (TTNT)	From start of index treatment until date of new therapy, or censoring date, whichever came first; during maximum follow-up of 45 months	TTNT was defined as the time from the index date to the initiation date of a new therapy. Initiation of a new therapy was defined by switching to a different NHT, switching to different therapies. Participants who did not initiate a new therapy were censored at the end of data availability or death, whichever came first. Index date was defined as the initiation date of NHT in 1L (any date) from 1-January-2020 to 31-December-2022. Retrospective data was retrieved using the Veterans' Health Administration data for period of 01-Jan-2020 to 30-Sep-2023 (45 months). Kaplan-Meier method was used for analysis.