Population Impact of Performing HRR Testing for Metastatic Castration-Resistant Prostate Cancer Treatment in the US
Author(s)
Bjerke A1, Patterson B1, Zielinkski M2, Su N2, Thompson A2, Meng Y1
1Lumanity, Bethesda, MD, USA, 2Pfizer, New York, NY, USA
Presentation Documents
OBJECTIVES: Talazoparib (a poly ADP-ribose polymerase inhibitor [PARPi]) with enzalutamide (an androgen-receptor pathway inhibitor [ARPi]) demonstrated benefit over enzalutamide for patients with metastatic castration-resistant prostate cancer (mCRPC) in the TALAPRO-2 trial. In the US, this combination is approved for HRR gene-mutated (HRRm) mCPRC, however, access to treatment is dependent on testing and current testing rates are low.
This analysis aimed to assess the US population-level clinical impact of HRR testing for patients with mCRPC.METHODS: Two testing strategies were assessed: 1) no HRR testing, where all patients received non-targeted treatments: enzalutamide, abiraterone, or docetaxel; and 2) universal HRR testing, where HRRm patients received PARPi+ARPi treatment, while non-HRRm patients received non-targeted treatments.
A model was used to inform efficacy for both strategies. With universal testing, overall survival (OS) and radiographic progression free survival (rPFS) for talazoparib + enzalutamide based on patient level data from TALAPRO-2 were used for HRRm patients treated with PARPi+ARPi. OS and rPFS for non-HRRm patients receiving non-targeted treatments were based on TALAPRO-2 data for enzalutamide and indirect treatment comparison (ITC) for abiraterone and docetaxel. Under no HRRm testing, OS and rPFS for non-HRRm patients with enzalutamide were estimated using hazard ratios of non-HRRm vs HRRm based on TALAPRO-2 data and ITC for abiraterone and docetaxel. Clinical benefits, measured as life years (LY) and quality-adjusted life years (QALY) gains, were derived from OS, rPFS and health utilities. The outcome of the no testing strategy was the weighted average of HRRm and non-HRRm patients with non-targeted treatments. Results were estimated on an individual level and extrapolated to the population level.RESULTS: The universal testing strategy provides 0.21 LY and 0.18 QALY gains per patient. For the 2024 US population cohort, the clinical benefits are 700 additional LYs and 599 additional QALYs.
CONCLUSIONS: The universal HRR testing strategy results in substantial population-level clinical benefits.
Conference/Value in Health Info
Value in Health, Volume 27, Issue 12, S2 (December 2024)
Code
CO48
Topic
Clinical Outcomes, Epidemiology & Public Health, Patient-Centered Research
Topic Subcategory
Comparative Effectiveness or Efficacy, Health State Utilities, Public Health
Disease
Oncology