Retrospective cohort study comparing ARIs; darolutamide, enzalutamide, and apalutamide in 870 non metastatic CRPC patients

[Graham49]

In this retrospective study (with limitations) comparing ARIs, darolutamide came out best. The results for enzalutamide and apalutamide were similar.

Androgen Receptor Inhibitors in Patients With Nonmetastatic Castration-Resistant Prostate Cancer

Daniel J. George, MD; Alicia K. Morgans, MD, MPH; Niculae Constantinovici, MD, MPH; Nasreen Khan, PhD; Javeed Khan, MS; Guifang Chen, PhD; Vlasta Hlebec, MD; Neal D. Shore, MD

JAMA Network Open. 2024;7(8):e2429783. doi:10.1001/jamanetworkopen.2024.29783

362 received darolutamide [41.6%]; 382, enzalutamide [43.9%]; 126, apalutamide [14.5%]); mean (SD) age was 78.8 (8.7) years.

The main outcome was a composite of 2 end points, treatment discontinuation and progression to metastatic CRPC (mCRPC), whichever occurred first. Both end points were also assessed separately.

In this cohort study of 870 patients with nmCRPC, darolutamide as initial ARI treatment was associated with significantly lower risks of discontinuation and progression to metastatic CRPC compared with enzalutamide and apalutamide, even after adjusting for patient baseline characteristics.

Despite limitations inherent to retrospective data collection, DEAR is the first large cohort study, to our knowledge, to use a single data source to assess prescription of all 3 ARIs approved for nmCRPC in routine clinical practice. Results suggest darolutamide is associated with longer treatment duration and time to progression to mCRPC compared with enzalutamide and apalutamide in a routine care setting, while no differences in either outcome were found between enzalutamide and apalutamide. The most common reasons for discontinuation (AEs, disease progression, and death) were numerically less frequent with darolutamide.

[Graham49]

An earlier comparison study found:

“For nmCRPC, darolutamide offered optimal efficacy and safety among approved drugs, and abiraterone acetate may offer comparable metastasis-free survival benefit with cost savings from generic availability. Future research is needed to more fully examine the benefit of abiraterone acetate.”

Comparison of Treatments for Nonmetastatic Castration-Resistant Prostate Cancer: Matching-Adjusted Indirect Comparison and Network Meta-Analysis

Lin Wang, MD, PhD, Channing Paller, MD, Hwanhee Hong, PhD, Lori Rosman, MLS, Anthony De Felice, MHS, Otis Brawley, MD, G Caleb Alexander, MD, MS

JNCI: Journal of the National Cancer Institute, Volume 114, Issue 2, February 2022, Pages 191–202, doi.org/10.1093/jnci/djab071

[j-o-h-n in reply to Graham49]

I'll show this post to my Greek teacher who can interpret it for me.

Good Luck, Good Health and Good Humor.

j-o-h-n