A slew of studies in the last half decade or so have compared treating patients, who have metastatic prostate cancer, with ADT alone, or ADT in combination with other agents, notably either abiraterone and prednisone or a second-generation anti-androgens. These combinations have come to be known as “doublet therapy.” If one adds in a chemotherapy agent like, docetaxel, that is now referred to as “triplet therapy.” Collectively these studies have pointed to better survival for these advanced patients when ADT is combined with at least one of the newer agents.
As patients survive longer on these intensified treatment protocols, it becomes important to look at not just their survival, but their health-related quality of life (HR-QoL). Inspired by that concern, an international group of uro-oncologists reviewed six important studies that have shown the benefit for prostate cancer treatment intensifications. Here the researchers focused specifically on patients’ HR-QoL.
As a general conclusion, the authors found that either enzalutamide or abiraterone, when combined with ADT, increased overall HR-QoL compared to ADT alone.
The authors flagged though a major problem in comparing these studies; i.e., they used a wide variety of measures of HR-QoL making it difficult to compare the studies. For example, two studies focussed on the time to “clinically meaningful deterioration.” Another looked at “patient reported deterioration.” Some looked at “progression;” others looked at “physical symptoms.” They may sound similar, but they are not.
The authors found in general that the combinations did not improve sexual function and the authors believed that was simply because the ADT alone would have greatly suppressed sexual function.
Patients were more likely to report loss of appetite, if they were taking enzalutamide and ADT rather than just ADT. The combination of darolutimide, ADT, and docetaxel led to a longer time to pain progression compared to ADT alone.
The studies were inconsistent in terms of what they reported on in terms of “emotional well-being” and “social and family well being.” None of the studies looked at the well-being of the intimate partners and caregivers of the patients.
In their key last paragraph, the authors write “We plea for a standardization of measurements to allow quantitative comparisons across future studies.” We would add to this that future studies should also look at the HR-QoL and welfare of the partners and caregivers of the patient’s since it has been known for a long time that ADT not only burdens prostate cancer patients directly, but indirectly also their loved ones.
Reference:
Afferi, L., Longoni, M., Moschini, M., Gandaglia, G., Morgans, A., Cathomas, R., Mattei, A., Breda, A., Scarpa, R. M., Papalia, R., de Nunzio, C., & Esperto, F. (2023). Health-related quality of life in patients with metastatic hormone-sensitive prostate cancer treated with androgen receptor signaling inhibitors: the role of combination treatment therapy. Prostate cancer and prostatic diseases, 10.1038/s41391-023-00668-0. Advance online publication. https://doi.org/10.1038/s41391-023-00668-0