Performance status and end-of-life outcomes in patients with metastatic castration resistant prostate cancer treated with androgen receptor targeted therapy

Abstract

Background Androgen receptor targeted therapies (ARTs) are widely preferred over taxane chemotherapy due to their good tolerability and similar efficacy. However, there is a paucity of data that supports the use of ART therapy or describes end-of-life (EOL) outcomes in mCRPC patients with reduced PS (PS) (ECOG ≥ 2). Methods We performed a retrospective, single-institution study of 142 patients with mCRPC who received ART therapy between 2010 and 2021. We assessed each record for baseline demographic and clinical information, ART treatment course, and survival and EOL outcomes. Our primary aim was to compare overall survival between the two groups (ECOG > 2 vs. 0-1), and our secondary aim was to describe EOL outcomes. Fisher's Exact Tests and Wilcoxon signed rank tests were used to compare baseline characteristics. Cox regression was used to compare overall survival (OS) for patients with ECOG ≥ 2 at the start of treatment with those who had an ECOG of 0 or 1. Descriptive analyses were performed to assess EOL outcomes between the groups. Results Patients with mCRPC and decreased PS experienced shorter overall survival on ART, compared to those with higher PS. Moreover, when examining EOL outcomes, a near majority of these patients died in the hospital, with a greater percentage among those with an ECOG ≥ 2. Conclusion These findings highlight the need for continual assessment of PS, improved shared decision-making in ART treatment, and additional research exploring the association between PS and EOL outcomes.