Health-related Quality of Life With ARPIs in mHSPC: Insights From a Network Meta-analysis

Androgen receptor pathway inhibitors (ARPIs) combined with androgen deprivation therapy (ADT) have transformed the management of metastatic hormone-sensitive prostate cancer (mHSPC). However, no head-to-head randomised controlled trials (RCTs) have directly compared ARPIs. This study compared the impact of darolutamide plus ADT versus other doublet ARPIs on patient-reported health-related quality of life (HRQoL) outcomes in men with mHSPC using a network meta-analysis (NMA) of RCTs. A Bayesian proportional hazards NMA was conducted using the Bayesian generalised linear model framework to compare time to deterioration in Functional Assessment of Cancer Therapy-Prostate (FACT-P) total score using data from the ARANOTE, ARCHES, TITAN, and LATITUDE studies. Darolutamide plus ADT showed a meaningful difference in delaying time to deterioration in FACT-P total score versus ADT (hazard ratio [HR] 0.76, 95% credible interval [CrI] 0.61-0.94) and apalutamide plus ADT (HR 0.74 [95% CrI 0.56-0.99]). Darolutamide plus ADT demonstrated numerically favourable effects compared with abiraterone plus ADT (0.89 [95% CrI 0.69-1.16]) and enzalutamide plus ADT (0.79 [95% CrI 0.60-1.04]), although there was no evidence of a difference. Across treatments, darolutamide plus ADT had the highest probability of being the most effective treatment for delaying deterioration in HRQoL. These findings suggest that darolutamide plus ADT may maintain HRQoL longer than other ARPIs and support darolutamide plus ADT as a patient-centred treatment option.