Evidence map›Paper›PMID 40838196›Full record

ArticleEClinicalMedicine2025

Impact of treatment suspension on health-related quality of life in the EMBARK trial: a post hoc analysis.

Stephen J Freedland, Ugo De Giorgi, Antti Rannikko, Fred Saad, Miguel Ramirez-Backhaus, Anchen F Nasr, Jasmina I Ivanova, Arijit Ganguli, Pavol Kral, Arlene L Reisman and 1 more

Registry-linked trialAbstract read
In one paragraph

Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02319837 (A Phase 3, Randomized, Efficacy and Safety Study of Enzalutamide Plus Leuprolide, Enzalutamide Monotherapy, and Placebo Plus Leuprolide in Men With High-Risk Nonmetastatic Prostate Cancer Progressing After Definitive Therapy), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02319837 phase3active not recruitingnot on this map

A Phase 3, Randomized, Efficacy and Safety Study of Enzalutamide Plus Leuprolide, Enzalutamide Monotherapy, and Placebo Plus Leuprolide in Men With High-Risk Nonmetastatic Prostate Cancer Progressing After Definitive Therapy

TypeinterventionalSponsorPfizerRan2014 to 2026Enrolled1,068ConditionsHormone Sensitive Prostate Cancer, Prostate Cancer, Cancer of the ProstateArmsEnzalutamide, Placebo (No longer applicable in Open Label study period), Leuprolide Open Label
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Stephen J FreedlandSamuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA.
Ugo De GiorgiIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), Dino Amadori, Via Piero Maroncelli, 40, 47014 Meldola FC, Italy.
Antti RannikkoDepartment of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital, Fabianinkatu 33, 00100 Helsinki, Finland.
Fred SaadCentre Hospitalier de l'Université de Montreal, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
Miguel Ramirez-BackhausInstituto Valenciano de Oncología, Carrer del Professor Beltrán Báguena, 8, Campanar, 46009 València, Valencia, Spain.
Anchen F NasrMedical Affairs, Astellas Pharma Inc., 2375 Waterview Dr, Northbrook, IL 60062, USA.
Jasmina I IvanovaPfizer Inc., 66 Hudson Blvd E, New York, NY 10001, USA.
Arijit GanguliMedical Affairs, Astellas Pharma Inc., 2375 Waterview Dr, Northbrook, IL 60062, USA.
Pavol KralIQVIA Inc., Vajnorská 100/B, 831 04 Bratislava, Slovakia.
Arlene L ReismanPfizer Inc., 66 Hudson Blvd E, New York, NY 10001, USA.
Neal D ShoreSTART Carolinas/Carolina Urologic Research Center, 823 82 Parkway, Suite B, Myrtle Beach, SC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Enzalutamide was approved for high-risk biochemically recurrent (hrBCR) prostate cancer based on the EMBARK trial (NCT02319837; 17 December 2014-31 January 2023). In EMBARK, treatment was suspended at week 37 if prostate-specific antigen (PSA) was <0.2 ng/mL and reinstated if PSA rose to ≥2.0 ng/mL with radical prostatectomy or ≥5.0 ng/mL without. This post hoc analysis assessed the impact of treatment suspension on health-related quality of life (HRQoL) to address overtreatment concerns. Methods: Longitudinal change in HRQoL from treatment suspension at week 37 to subsequent assessments until week 109 was analyzed with mixed models for repeated measures (MMRM) and descriptively among these patients. Separate models were used to assess four patient-reported outcome (PRO) instruments-Brief Pain Inventory - short form, Functional Assessment of Cancer Therapy - Prostate, QoL Questionnaire - Prostate 25, and European QoL 5-Dimensions 5-Levels health questionnaire-with predefined clinically meaningful thresholds. Intention-to-treat analysis was used. Findings: Treatment was suspended in 90% (321/355), 86% (304/355), and 67% (240/358) of participants treated with enzalutamide + leuprolide, enzalutamide monotherapy, and leuprolide alone, respectively. MMRM showed no meaningful change in any treatment arm after treatment suspension across all assessed PRO measures, except hormonal treatment-related symptoms, for which clinically meaningful improvement was observed after treatment suspension at week 61 for enzalutamide monotherapy, week 73 for leuprolide alone, and week 85 for enzalutamide + leuprolide. The descriptive analysis showed similar findings. Interpretation: Enzalutamide ± leuprolide in patients with hrBCR improves metastasis-free survival versus leuprolide alone with no clinically meaningful changes in the measured HRQoL domains during treatment or after treatment suspension, with gradual improvement in hormonal treatment-related symptoms after treatment suspension in this selective clinical trial population. Further real-world studies are warranted to better explore the benefits of treatment suspension. Funding: This study was funded by Pfizer Inc. and Astellas Pharma Inc.

Indexed as

EnzalutamideMMRM analysisPatient-reported outcomesQuality of life

Identifiers

PMID40838196
PMCPMC12362394

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.