Chemohormonal therapy with androgen deprivation therapy and docetaxel (ADT + D) improves overall survival (OS) and quality of life (QOL) at 12 mo versus androgen deprivation therapy (ADT) alone in men with metastatic hormone-sensitive prostate cancer (mHSPC). However, the prognostic role of QOL is unknown in this population.
To study the relationship between QOL, disease characteristics, and OS in men with mHSPC.
In this exploratory post hoc analysis, 790 patients with mHSPC completed the QOL instruments Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Brief Pain Inventory (BPI).
Log-rank test and Cox proportional hazard models tested the association between QOL and OS by clinical and disease characteristics.
Baseline higher FACT-P trended toward improved survival after accounting for clinical variables (hazard ratio [HR] 0.80 [0.62, 1.04], p = 0.09), while higher 3-mo FACT-P was independently associated with better survival (HR 0.76 [0.58, 1.0], p = 0.05). Patients with the poorest QOL (bottom quartile) at baseline and 3 mo had longer survival if they received ADT + D rather than ADT alone (median OS 45.2 vs 34.4 mo, HR 0.75 [0.53, 1.05], p = 0.09, and 48.3 vs 29.3 mo, HR 0.69 [0.48, 0.99], p = 0.05 respectively). In contrast, patients with the best QOL (top quartile) at baseline and 3 mo had comparable survival irrespective of whether or not docetaxel was added (median OS 72.1 vs 51.7 mo, HR 0.92 [0.63, 1.36], p = 0.69, and 69.9 vs 68.9 mo, HR 1.11 [0.73, 1.67], p = 0.63, respectively). Survival was linked with baseline FACIT-F (HR 0.76 [0.57, 1.0], p = 0.05), but not BPI (HR 0.98 [0.75, 1.28], p = 0.90).
Three-month QOL had a stronger independent association with survival. The most symptomatic patients had longer survival with the addition of docetaxel; conversely, the least symptomatic patients did not appear to benefit. Consideration of QOL may enhance decision-making and patient selection when choosing chemohormonal treatment in mHSPC.
Quality of life independently forecasted the survival of men with metastatic hormone-sensitive prostate cancer in the CHAARTED study. Close tracking of quality of life could help patients and clinicians make decisions about the appropriate treatment in this setting.
European urology oncology. 2024 Apr 29 [Epub ahead of print]
Daniel Sentana-Lledo, Xiangying Chu, David F Jarrard, Michael A Carducci, Robert S DiPaola, Lynn I Wagner, David Cella, Christopher J Sweeney, Alicia K Morgans
Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: ., Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA, USA., University of Wisconsin Hospital and Clinics, Madison, WI, USA., Johns Hopkins University, Baltimore, MD, USA., University of Kentucky College of Medicine, Lexington, KY, USA., University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA., Northwestern University, Chicago, IL, USA., South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia., Dana-Farber Cancer Institute, Boston, MA, USA.