Analysis of quality-adjusted time without symptoms or toxicity (Q-TWiST) in patients with metastatic hormone-sensitive prostate cancer from the ARASENS trial.
Brigida A Maiorano, Matthew R Smith, Maha Hussain et al.
✦ AI-curated · Sources linked
In 30 seconds
This Q-TWiST analysis of the multicenter, randomized ARASENS trial evaluated quality-adjusted survival in patients with metastatic hormone-sensitive prostate cancer receiving darolutamide plus androgen deprivation therapy (ADT) and docetaxel, versus placebo plus ADT and docetaxel. Over a 53-month restricted-mean analysis, darolutamide was associated with 6.3 additional months of quality-adjusted time without symptoms or toxicity (Q-TWiST; p < 0.001). This reflected more time without symptoms or toxicity and less time with relapse or disease progression, alongside more time with grade 3/4 toxicity.
Key findings
- Q-TWiST was 6.3 months longer with darolutamide than placebo (p < 0.001); relative Q-TWiST gain was 16.0%.
- Mean time without symptoms or toxicity was 17.6 months with darolutamide versus 10.9 months with placebo.
- Mean time in relapse or disease progression was 2.4 months with darolutamide versus 8.7 months with placebo.
- Mean time with grade 3/4 toxicity was 17.2 months with darolutamide versus 11.3 months with placebo at 53 months.
Why it matters
Q-TWiST combines survival time with time spent in clinically distinct health states, helping describe the balance between disease control and treatment toxicity. These results suggest that the quality-adjusted benefit of adding darolutamide was not captured by toxicity duration alone, and provide a patient-centred perspective on outcomes in this trial population.
What to keep in mind
This was a secondary analysis using utility-weighted health states and restricted-mean estimates; its results depend on the selected health-state definitions and utilities.