Impact of enzalutamide (ENZA) vs. bicalutamide (BIC) on health-related quality of life (HRQoL) of patients (pts) with castration-resistant prostate cancer (CRPC): STRIVE study.

234 Background: In STRIVE pts with CRPC (M0 n = 139; M1 n = 257), median time to 10-point decrease from baseline in FACT-P total for ENZA vs. BIC was 8.4 vs. 8.3 months (hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.70, 1.19; p = 0.49). That assumed missing data was missing at random (MAR) and censored pts with no deterioration in FACT-P at last assessment. As HRQoL may worsen after progression/adverse events, for all STRIVE pts we replaced the MAR assumption with assumptions more likely to reflect clinically plausible HRQoL decline. Methods: Analyses of HRQoL decline (minimum clinically important difference or higher decrease in FACT-P vs. baseline) used a missing not at random (MNAR) assumption using a pattern mixture model (PMM) via sequential modeling with multiple imputation when imputation varies by reason of treatment discontinuation. Analysis of time to first clinically meaningful deterioration vs. baseline used a piecewise exponential survival multiple imputation model with reason-specific ∆ adjustment patterns similar to PMM analysis. Results: PMM analysis showed differences at week 61 in mean HRQoL change from baseline favoring ENZA vs. BIC for 7 of 10 scores: physical (PWB), functional, emotional (EWB), and social (SWB) well-being; FACT-P trial outcome index; FACT-G total; FACT-P total (all clinically meaningful except PWB). In the piecewise exponential survival imputation model, ENZA had a significantly lower risk of first deterioration in FACT-P total (0.76 [0.60, 0.95]), FACT-G total (0.66 [0.52, 0.83]), Prostate Cancer Subscale (PCS) pain-related (0.78 [0.62, 0.97]), SWB (0.49 [0.38, 0.64]), and EWB (0.58 [0.45, 0.75]) vs. BIC. For remaining domain scores, ENZA reduces risk of first deterioration (HR < 1) but the 95% CI includes 1 (which means not significant); sensitivity analysis showed similar results. Conclusions: In STRIVE pts, declines in all FACT-P scores were smaller for ENZA vs. BIC up to week 61. Comparison of change from baseline at week 61 favored ENZA for 7 of 10 scores (6 clinically meaningful). ENZA had a significantly lower risk of first deterioration in FACT-P or FACT-G total, PCS pain-related, EWB, and SWB. Clinical trial information: NCT01664923.

Duke Scholars

Author Andrew John Armstrong Medicine, Medical Oncology