Recent Advances In The Treatment Of Metastatic Castration Resistant Prostate Cancer: Impact On Health Related Quality Of Life

Abstract

OBJECTIVES: Metastatic castration-resistant prostate cancer (mCRPC) continues to be an aggressive and life-threatening cancer. With approved drugs providing only modest survival benefits, there is an increasing interest on improving symptoms and health-related quality of life (HRQoL). The aim of this review is to understand the impact of mCRPC treatments on HRQoL. METHODS: The search was conducted on PubMed®. Additional articles were found from crossreferencing, and on ASCO and ESMO websites. A multi-step approach ensured that a wide range of mCRPC studies were reviewed. The search was limited to English, human-only abstracts from January 1, 1992 to December 31. RESULTS: Quality of life evaluations for the following compounds were included in the review: abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, radium-223, samarium-153, and strontium-89. Significantly greater quality of life response was observed in the enzalutamide population compared to placebo (43% vs. 18%) while docetaxel showed significant difference in a head-to-head comparison with mitoxantrone on pain response (31-35% vs. 22%) as measured by the McGill questionnaire. Cabazitaxel did not show a significant difference in pain response compared to mitoxantrone. Abiraterone showed significant difference in multiple outcomes: pain palliation (44% vs. 27%) as measured by BPI-SF; reduction in fatigue intensity (58% vs. 40%) as measured by BFI; and time to HRQoL degradation (12.7 vs. 8.3 months) as measured by FACT-P. Abiraterone is the only agent reviewed to be effective in survival, pain palliation and progression and HRQoL. Additionally, abiraterone uniquely measured and showed benefit in fatigue. No patient-reported outcomes were pursued for sipuleucel-T. EORTC QLQ-C30 and FACT-P were the most common HRQoL instruments used. CONCLUSIONS: Studies in mCRPC typically include endpoints for pain palliation and quality of life improvement. Additionally, novel therapies are focusing on pain associated with bone metastases. There is no standard HRQoL or pain instrument being consistently used across prostate cancer trials.