(UroToday.com) The 2023 ESMO annual meeting included a session on prostate cancer, featuring a presentation by Dr. Michael Morris discussing the association of health-related quality of life with efficacy outcomes in the VISION study of patients with metastatic castration-resistant prostate cancer (mCRPC). The phase 3 VISION trial1 demonstrated that 177Lu-PSMA-617 and protocol-permitted standard of care in patients with PSMA-positive mCRPC significantly prolonged radiographic progression-free survival (rPFS) and overall survival (OS) relative to standard of care alone. The objective of this post hoc analysis of VISION assessed associations of Prostate prostate-specific antigen (PSA) decline, rPFS and OS with time to worsening of health-related quality of life.
Associations of PSA decline with time to worsening of health-related quality of life (n = 385) were assessed in the 177Lu-PSMA-617 arm. Patients were grouped by PSA decline (unconfirmed) overall or up to 12 weeks of treatment:
- No decline
- ≤ 50%
- > 50 to ≤ 90%
- > 90%
Worsening of health-related quality of life was defined as:
- A decrease of ≥ 10 (total) or ≥ 3 (subdomain) points in FACT-P
- An increase of ≥ 2 points in BPI-SF
- Any decrease in EQ-5D-5L
Associations of rPFS or OS with time to worsening of health-related quality of life were carried out in the full analysis set (n = 831) using three Spearman’s rank methods, with and without imputation for missing OS and rPFS data.
In the 177Lu-PSMA-617 arm, greater PSA decline overall and up to 12 weeks of treatment was associated with longer median time to worsening in FACT-P total and subdomain scores. The following figure shows the results for emotional well-being (the domain with the most apparent difference in median time to worsening by PSA decline) and functional well-being:
The following figure shows the results for physical well-being and social and family well-being:
The following figure shows the results for the prostate subscale and pain related subscale:
Similar results were observed for BPI-SF and EQ-5D-5L:
In the 177Lu-PSMA-617 arm, correlations of rPFS and OS with time to worsening health related quality of life were mainly weak or moderate:
Dr. Morris concluded his presentation discussing the association of health-related quality of life with efficacy outcomes in the VISION study of patients with mCRPC with the following concluding statements:
- In 177Lu-PSMA-617 treated patients, larger magnitudes of PSA declines were associated with longer time to worsening in FACT-P total score and its subdomains. Similar results were seen for BPI-SF, and, to a less extent, EQ-5D-5L
- Increased rPFS and OS were mildly or moderately correlated with increased time to worsening in health related quality of life in 177Lu-PSMA-617 treated patients
Presented by: Michael Morris, MD, Medical Oncologist Clinical Director, Genitourinary Medical Oncology Service & Prostate Cancer Section Head, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2023 European Society of Medical Oncology (ESMO) Annual Meeting, Madrid, Spain, Fri, Oct 20 – Tues, Oct 24, 2023.
References: