Black and Hispanic patients have a high burden of prostate cancer mortality and this may be related to barriers to treatment. In 2010, Sipuleucel-T immunotherapy was the first FDA approved agent (since docetaxel) for metastatic castration resistant prostate cancer (mCRPC). We sought to identify whether there was disparity in the utilization of immunotherapy in the treatment of black and hispanic patients with mCRPC.


Using the National Cancer Database, we identified patients between 2010-2015 with likely minimally/asymptomatic mCRPC: PSA 50-200ng/ml, Charlson 0-2, age <70, stage M1, treated with chemotherapy or immunotherapy. We analyzed annual trends for chemotherapy and immunotherapy use and compared utilization by demographic and clinical features. Multivariate analysis was performed to determine predictors of receiving immunotherapy vs chemotherapy.


1238 patients were included. Most were Non-hispanic white (63%), with private insurance (46.4%). Overall, there was increased utilization of immunotherapy from 2010 to 2013 (from 3.8% to 39.8%), followed by decrease to 10.9% in 2015 and, simultaneously, there was decreased utilization of chemotherapy from 2010 to 2013 (from 96.2% to 60.2%). The increased use of immunotherapy was predominantly in white patients and not seen in black and Hispanic patients (Figure 1). Relative to chemotherapy, immunotherapy was less likely to be used in a comprehensive community cancer program (OR 0.52, 95% CI 0.30 – 0.89), and patients with mid-high SES (OR 0.49, 95% CI 0.31 – 0.78).


FDA approval of Sipuleucel-T in 2010 for mCRPC led to increased utilization of immunotherapy shortly thereafter, but this was mainly in white patients. Black and Hispanic patients proportionately did not exhibit increased utilization of this novel agent after 2010. Further study is necessary to help understand barriers to access to new treatment in mCRPC and eliminate the burden of disease in minority populations.

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