Health-related quality of life in metastatic hormone sensitive prostate cancer (mHSPC): Insights from a network meta-analysis of treatment options.

Abstract

e17092 Background: Health-related quality of life (HRQoL) directly impacts both disease control outcomes and the patient experience playing a significant role in clinical decision-making. As the treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC) continues to evolve, it is essential to have comparative evidence on HRQoL to support informed clinical choices. This study compares HRQoL outcomes as measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) instrument across androgen receptor pathway inhibitor (ARPI) trials in mHSPC. Methods: A Bayesian proportional hazard network meta-analysis (NMA) was conducted to compare time to deterioration in FACT-P total score utilizing data from ARANOTE, ARCHES, TITAN, and LATITUDE, selected following a feasibility assessment. Time to deterioration was defined consistently across trials as a clinically meaningful reduction in FACT-P score of 10 points from baseline to ensure comparability of results. Fixed or random effects models were chosen based on model goodness of fit (GoF) statistics, such as Deviance Information Criterion (DIC) and residual deviance. The Surface Under the Cumulative Ranking Curve (SUCRA) method was used to derive treatment rankings. Results: Given the minimal differences in DIC and residual deviance, the fixed effects model was selected based on a priori assessment of low heterogeneity across studies. Darolutamide + ADT showed a significant improvement in time to deterioration in FACT-P total score compared to both ADT monotherapy and apalutamide + ADT, with a favorable trend observed versus both abiraterone + ADT and enzalutamide + ADT. The SUCRA rankings suggest that darolutamide + ADT had the highest probability of being the most effective treatment for delaying deterioration in HRQoL (Table 1). Conclusions: The analysis suggests that darolutamide + ADT may provide HRQoL advantages compared to other ARPIs +ADT. This finding may be an important component of patient-centered treatment decision-making in mHSPC. Results from the HRQoL NMA: Time to deterioration in FACT-P total score. Treatments HR* (95% Crl**) SUCRA (%) Darolutamide + ADT Reference 93% Abiraterone + ADT 0.89 (0.69, 1.16) 74% Enzalutamide + ADT 0.79 (0.60, 1.04) 39% ADT 0.76 (0.61, 0.94) 23% Apalutamide + ADT 0.74 (0.56, 0.99) 20% *Hazard Ratio. **Credible Interval.