European journal of cancer (Oxford, England : 1990)
October 2, 2026 · via Europe PMC
Analysis of quality-adjusted time without symptoms or toxicity (Q-TWiST) in patients with metastatic hormone-sensitive prostate cancer from the ARASENS trial.
Maiorano BA, Smith MR, Hussain M, +8 more, Fizazi K
AI summary — for doctors, generated from the abstract only
Adding darolutamide to ADT plus docetaxel gave patients about 6.3 more months of quality-adjusted survival without symptoms or toxicity in metastatic hormone-sensitive prostate cancer.
What was studied
A Q-TWiST analysis of the ARASENS trial comparing darolutamide + ADT + docetaxel with placebo + ADT + docetaxel, partitioning time into toxicity, symptom-free, and relapse states using 53-month restricted means.
Key findings
- Patients gained an additional 6.3 months of Q-TWiST with darolutamide versus placebo
- Health states were defined by grade 3/4 adverse events, time to metastatic castration-resistant disease, and overall survival
- Q-TWiST was computed as the utility-weighted sum of time in each health state per arm
Clinical relevance
Weighing survival gain against toxicity helps clinicians and patients judge whether intensified triplet therapy is worth its adverse-event burden.
Who should care
Limitations
The abstract is cut off in the results (the p-value and further detail are missing), so subgroup results and precision cannot be reported. It is a post hoc analysis of a single trial and depends on assumed utility weights.
Triplet therapy appears to preserve more quality-adjusted, toxicity-free time, but exact results beyond the 6.3-month gain are unavailable from this abstract.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
To identify patients likely to benefit from intensified darolutamide treatment while minimizing adverse events (AEs), this analysis applied quality-adjusted time without symptoms or toxicity (Q-TWiST) to evaluate quality-adjusted survival in metastatic hormone-sensitive prostate cancer in ARASENS, comparing triplet therapy (darolutamide + androgen deprivation therapy [ADT] + docetaxel) with placebo doublet therapy (ADT + docetaxel).
METHODS
Time with toxicity (TOX; with grade 3/4 symptoms/toxic effects), time without symptoms or toxicity (TWiST), and time in relapse/disease progression (REL) were estimated using 53-month restricted means based on grade 3/4 AEs, time to metastatic castration-resistant prostate cancer, and overall survival ARASENS data. Q-TWiST was calculated as the utility-weighted sum of time spent in each health state per treatment arm.
RESULTS
Patients gained an additional 6.3 months of Q-TWiST with darolutamide versus placebo (p < 0.001) driven by increased TWiST (mean 17.6 months vs 10.9 months), and decreased REL (2.4 months vs 8.7 months). Longer treatment resulted in more TOX (17.2 months vs 11.3 months) at 53 months. Partitioned Kaplan-Meier survival curves showed sustained TWiST with darolutamide versus placebo over 53 months. Relative Q-TWiST gain was 16.0% (clearly clinically important).
CONCLUSION
Darolutamide triplet therapy offers longer survival benefits without symptoms or toxicity versus placebo, aiding evaluation of efficacy-tolerability balance and supporting patient-centered decision-making.
DOI
10.1016/j.ejca.2026.117764
PMID
42892235
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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