Rush, Hannah Louise;
(2023)
Factors that influence choice between treatment options in men with hormone-sensitive prostate cancer.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Prostate cancer is an important cause of morbidity and mortality worldwide. Androgen deprivation therapy (ADT) forms the backbone of treatment for men with newly diagnosed advanced hormone sensitive prostate cancer (HSPC). Trials demonstrate that adding systemic treatment (docetaxel, abiraterone, enzalutamide, apalutamide or darolutamide) to ADT improves cancer outcomes in this setting. Furthermore, emerging data supports the efficacy of new ADT options (transdermal oestradiol (tE2) and oral LHRH antagonists (relugolix)). Now choice between types of ADT and additional systemic therapy is increasing the complexity of treatment decisions in this setting. This thesis investigated specific characteristics of several of these treatments, aiming to provide new data to inform patient consultations. Analysis of data from the STAMPEDE trial found that men randomly allocated to receive ADT plus abiraterone reported higher global quality-of-life scores compared to men allocated to receive ADT plus docetaxel. A systematic review explored adverse events (AEs) reported in clinical trials evaluating tE2 and relugolix. A narrative review of AEs occurring during tE2 treatment identified similar AEs as previously reported for injected oestrogens. A meta-analysis found similar relative risk of many AEs occurring during treatment with relugolix in comparison to injected ADT, although a lower risk of CVS events in those treated with relugolix. Early indicators of efficacy and safety were found to be similar in men treated with the novel combination of tE2 and either abiraterone or enzalutamide and those treated with LHRH and either abiraterone and enzalutamide. Finally, a qualitative study explored men’s choices between injected ADT, tE2 and relugolix. Discussions revealed men made different treatment choices based on their priorities which were influenced by their experiences, beliefs and hopes/worries at the time of decision making. This work evaluating different aspects of treatments for advanced HSPC has explored and defined important data that will inform treatment decisions.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Factors that influence choice between treatment options in men with hormone-sensitive prostate cancer |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10177654 |
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