The Impact of Enzalutamide on the Prostate Cancer Patient Experience: A Summary Review of Health-Related Quality of Life across Pivotal Clinical Trials

SIMPLE SUMMARY: Patients with prostate cancer often experience pain, fatigue and other negative symptoms that can lead to poorer quality of life. Enzalutamide is a prostate cancer therapy that is effective across the disease continuum from early-state cancer patients through to patients with metastatic castration-resistant disease. In this study, we evaluated how enzalutamide impacts patients’ quality of life. We found that patients with early disease maintained low pain levels and symptom-related burden when treated with enzalutamide or with a control treatment, and that patients with advanced disease who received enzalutamide experienced mitigated negative impacts compared to controls. Furthermore, it took longer for patients treated with enzalutamide to report experiencing a reduction in quality of life, and this was most pronounced for patients with advanced cancer. Enzalutamide can be tolerated by patients with early or advanced prostate cancer and delays both disease progression and the associated deterioration of quality of life. ABSTRACT: This review examines the impact of treatment with enzalutamide on health-related quality of life (HRQoL) in prostate cancer patients across the disease continuum based on pivotal clinical trials. We assessed the effect of enzalutamide on pain, symptom burden and overall HRQoL from randomized controlled trials. Patient experience was evaluated in men with metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) (pre-chemotherapy and post-chemotherapy). Patients across the disease continuum reported a generally positive status at baseline, with relatively low levels of pain and impairment due to cancer-related symptoms and high HRQoL. For patients with earlier-state prostate cancer, pain and symptom-related burden were low at study entry and remained so, regardless of whether patients received enzalutamide or control treatment. Patients with more advanced disease reported mitigation in pain and symptom burden while receiving treatment with enzalutamide. Enzalutamide was observed to slow deterioration of overall HRQoL most for patients with nmCRPC or mCRPC (statistical significance for between-group difference in median time to deterioration: mHSPC (confirmed) p = 0.2998; nmCRPC (confirmed) p = 0.0044; mCRPC (unconfirmed) p < 0.0001). Across the prostate cancer continuum, enzalutamide is well-tolerated and delays the negative impact that disease progression has on quality of life.