Time from medication order to administration of cabazitaxel (C) vs. lutetium Lu-177 vipivotide tetraxetan (Lu) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Jo Yeonjung , Hage Chehade Chadi , Ozay Zeynep Irem , Gebrael Georges , Sayegh Nicolas , Hardy Richard , HU Siqi , Tripathi Nishita , Chigarira Beverly , Nordblad Blake , Ji Richard , Garg Diya , Galarza Fortuna Gliceida M , Mathew Thomas Vinay , Li Haoran , Roy Soumyajit , Maughan Benjamin L. , Riaz Irbaz Bin , Agarwal Neeraj , Swami Umang 
Published: February 2025

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Background:
C and Lu are associated with overall survival benefit and approved for pts with mCRPC after prior treatment with docetaxel and an androgen receptor pathway inhibitor (ARPI). However, in real-world settings, administering Lu requires coordination across specialties and resources [PMID: 36637862], which could delay its administration. Herein, we sought to compare the time from medication order to administering the first dose of C versus Lu.
Methods:
This study used pt level data from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Inclusion criteria: availability of the date of the first order of single-agent C or Lu and the date of first administration of the drugs. The time between the first medication order to the administration of single-agent C or Lu was measured. Wilcoxon rank-sum test was used to compare the median days between medication order to administration between these 2 agents and a stratified analysis by practice type and insurance was performed.
Results:
Of 2,329 orders, 2,045 orders were for C between 1/1/2013 and 1/26/2024, while 284 were for Lu between 8/1/2013 and 12/6/2023. The time from medication order to administration was significantly longer with Lu (median 22 days, IQR 12-43) compared to C (median 7 days, IQR 3-14, p < 0.001). Time from medication order to administration of C and Lu by practice type and insurance is summarized (Table). At the time of the first order, pts in Lu cohort, compared to C cohort, were significantly older (median age 74 vs. 72, p < 0.001), more likely to be treated at an academic practice (27% vs. 15%, p < 0.001), and more likely to be covered by a commercial health plan (80% vs. 73%, p < 0.001).
Conclusions:
Our results show that it takes significantly longer to administer Lu compared to C across different practice types and most insurance plans. These results could inform healthcare policies aimed at improving access to Lu and guide treatment selection in the clinic.

Time from medication order to administration of C and Lu by practice type and insurance.

Category
Subtype (number of orders for C/number of orders for Lu)
CN = 2045
LuN = 284
p-value

Practice type, mean (range) (days)
Academic (315/77)
1.3 (0 – 59)
9.2 (0 – 55)
< 0.001

Community (1730/207)
13 (0 – 243)
44 (1 – 282)
< 0.001

Insurance, mean (range) (days)
Commercial (1494/226)
11 (0 – 163)
32 (0 – 215)
< 0.001

Medicare/other government programs (266/46)
10 (0 – 120)
46 (0 – 282)
< 0.001

Medicaid (32/2)
9 (0 – 76)
28 (0 – 55)
0.8

Others (72/6)
12 (0 – 42)
21 (0 – 41)
0.2

Unknown (181/4)
14 (0 – 243)
76 (39 – 91)
< 0.001