And now for real: outcomes of castration-resistant prostate cancer patients in the Netherlands

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The CAstration-resistant Prostate cancer RegIstry (CAPRI) has provided evidence on
differences between trial and real world populations (Part 1). Based on strict selection
criteria at baseline, outcomes in trial populations are more favorable compared to the
real world. Trials have provided efficacy data on new life prolonging drugs (LPDs) but
effectiveness in CAPRI was lower in patients with differential baseline characteristics.
To ensure optimal outcomes, the importance of an adequate estimation of the trial
eligibility and health status of metastatic castration-resistant prostate cancer (CRPC)
patients in daily practice is important to ensure optimal treatment outcomes.

In CAPRI, real world outcomes in CRPC were studied (Part 2). LPDs have led to increased
treatment options in CRPC patients, which was related to increased overall survival in
the period 2010-2018. Over time the course of disease still has a negative impact on
health-related quality of life (HRQoL), with deterioration in all domains, especially with
respect to role and physical functioning. These domains need specific attention during
follow-up to maintain HRQoL as long as possible by timely start of adequate supportive
care management. In the end of life phase, we observed a high intensity care in 41%
of CRPC patients. This high intensity care is not easily justifiable due to high economic
cost and little effect on life span or improvement of quality of life.

Lessons from real world data may help to improve routine care (Part 3). We observed
no differences in outcomes of patients treated with sequential abiraterone acetate plus
prednisone and enzalutamide with or without interposed chemotherapy or radium-
223, with low response rates (around 20% PSA responses) of the second treatment.
The additional effect of a second treatment with abiraterone or enzalutamide in daily
practice is therefore questioned. Prospective trials have confirmed this observation.
In the next chapter, we developed a prognostic model and identified a subgroup of
patients in whom third-line LPD treatment has no meaningful benefit, although this has
to be confirmed in prospective trials. In the last chapter, we presented a detailed guide
for clinicians through the (sometimes complex) steps in developing a useful prediction
model for CRPC patients.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
  • de Groot, Carin, Supervisor
  • Gerritsen, WR, Supervisor
  • van den Eertwegh, AJM (Fons), Supervisor
Award date8 Jul 2022
Place of PublicationRotterdam
Print ISBNs978-94-6421-586-1
Publication statusPublished - 8 Jul 2022


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