To evaluate contemporary patterns in the use of bone-modifying agents (BMAs) among patients with metastatic castration-resistant prostate cancer (mCRPC).
Approach:
Data Source: Patient-level data were extracted from the Flatiron Health Research Database, which includes deidentified data from approximately 280 US cancer clinics.
Study Design: A cohort study was conducted, including patients diagnosed with mCRPC, with a focus on BMA receipt after diagnosis.
Statistical Analysis: Statistical differences between groups were assessed using Wilcoxon rank-sum test for continuous values and Pearson χ2 test for categorical values.
Key Findings:
Among 14,076 patients with mCRPC, 56.6% received BMAs, while 43.4% did not.
BMA receipt varied over time, with lower use observed in more recent years (2013: 57.6%, 2019: 55.5%, 2024: 44.4%).
Denosumab use decreased over time, while zoledronic acid use increased among BMA recipients.
Interpretation:
The study highlights a significant gap between clinical guidelines recommending BMA use and actual clinical practice, with a notable proportion of patients not receiving BMAs.
Limitations:
Potential residual confounding and selection bias.
Misclassification due to technology-enabled abstraction.
Missing data on BMA order or administration may lead to underestimation of use.
Conclusion:
Efforts are needed to increase awareness of bone health and facilitate timely initiation of BMAs in patients with mCRPC.
by Zeynep Irem Ozay, Yeonjung Jo, Georges Gebrael, Micah Ostrowski, Vinay Mathew Thomas, Haoran Li, Ryon P. Graf, Soumyajit Roy, Benjamin L. Maughan, Avirup Guha, Irbaz Bin Riaz, Emmanuel S. Antonarakis, Rana R. McKay, Neeraj Agarwal, Umang Swami
