Pain is an important dimension of quality-of-life in patients with metastatic castrate-sensitive prostate cancer (mCSPC). However, it is unclear if dynamic change in pain over time can predict for overall survival (OS) or radiographic progression-free survival (rPFS) in these patients.
This is an exploratory analysis of LATITUDE, a phase III randomized study, in which men with de novo mCSPC were randomized to receive either ADT plus abiraterone versus ADT alone. Information was collected on patient-reported worst pain score (WPS) and pain-interference score (PIS) from the Brief Pain Inventory-Short Form. A Bayesian joint modelling approach was used determine the association of dynamic change in WPS and PIS with OS and rPFS.
Overall, 1125 patients with at least 3 measurements on pain scores were eligible. On Cox multivariable regression, increase in baseline WPS was associated with inferior OS (hazard ratio [HR] 1.049 [95% confidence intervals [CI] 1.015-1.085]; time dependent area under curve [tAUC] 0.64) and rPFS (HR 1.045 [1.011-1.080]; tAUC: 0.64). Increase in baseline PIS was associated with inferior OS (HR 1.062 [1.020-1.105]; tAUC: 0.63) but not with rPFS (HR 1.038 [0.996-1.08]). On independent joint models, an increase in the current value of WPS by 1-unit was associated with inferior OS (HR 1.316 [1.258-1.376]; tAUC 0.74) and rPFS (HR 1.319 [1.260-1.382]; tAUC 0.70). Similar association was seen for increase in the current value of PIS with OS (HR 1.319 [1.261-1.381]; tAUC 0.73) and rPFS (HR 1.282 [1.224-1.344]; tAUC 0.73).
The above findings highlight the potential dynamic interplay between patient-reported pain with OS and rPFS in mCSPC. Compared to baseline pain, such dynamic assessment of pain was found to have superior predictive ability and thus has the potential to tailor subsequent treatment based on response to initial therapy beyond its role as a very important dimension of quality-of-life.
Prostate cancer and prostatic diseases. 2022 Sep 13 [Epub ahead of print]
Soumyajit Roy, Scott C Morgan, Christopher J D Wallis, Yilun Sun, Daniel E Spratt, Julia Malone, Scott Grimes, Dibya Mukherjee, Amar U Kishan, Fred Saad, Shawn Malone
Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA. ., Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada., Division of Urology, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA., University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA., University of Ottawa, Ottawa, ON, Canada., Institute of Computational Biology, Bengaluru, India., Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., Department of surgery, Université de Montréal, Montreal, QC, Canada., Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada. .