apalutamide shows 23% survival benefit over enzalutamide in prostate cancer study

[Maxone73]

“This real-world evidence showed a statistically significant and clinically meaningful improvement in survival with apalutamide over enzalutamide in patients with mCSPC at 24 months,” said Dr Neal Shore

pharmatimes.com/news/erlead...

NOTE: it's not a double blind placebo trial...it's an observational study, with all the limits involved in a retrospective study...on the positive side, the sample is big and being real-world cases, patients selection bias is not in the equation

[KocoPr]

Now we need darolutamide in that equation.

[Maxone73 in reply to KocoPr]

for what it's worth, neal shore is also in this indirect comparison study:

journals.lww.com/auajuro/fu...

then thee is

targetedonc.com/view/darolu...

but it's all in non metastatic settings I think...all the studies I have found in this setting favour darolutamide

[KocoPr in reply to Maxone73]

Interesting and it is also importantly castrate resistant setting in both links.

The first article dated 2021 had less side effects of daro but no diff in PFS

While the second article statement below shows daro less likely to progress to metastatic disease.

Patients with non-metastatic castration-resistant prostate cancer (nmCRPC) treated with darolutamide (Nubeqa) were less likely to develop metastatic disease or discontinue treatment due to adverse events than patients treated with enzalutamide (Xtandi) or apalutamide (Erleada), according to research presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium.

Either way daro is the better choice and is approved for hormone sensitive disease. Which is huge to get on this latest generation of ARSi as early as possible.

[Mgtd in reply to KocoPr]

Thanks for including both generic and brand names.

[Rolphs]

I'm curious if anyone on the forum has switched from enzalutamide to apalutamide either before or after the enzalutamide stopped working. I've searched some of the research articles on this but haven't found anything definitive on this. I think in most cases after you become castrate resistant switching ARI drugs is not effective. My oncologist tried to get me on apalutamide after my DX but my insurance company wouldn't approve it unless I've already tried Enza. Maybe I should have tried to get paid for another way.

[Tinkudi]

does this mean those who have newly started on xtandi should prefer Erleada and switch ?

[Maxone73 in reply to Tinkudi]

Good question! I would not rush any decision and wait for this comparison to be confirmed

[Tinkudi in reply to Maxone73]

Does this trial not confirm that ?

[Maxone73 in reply to Tinkudi]

well, they aim to help doctors to suggest the right drugs to their patients, but are they completely sure about their suggestion?

[Tinkudi in reply to Maxone73]

What do you mean by are they completely sure

[Maxone73 in reply to Tinkudi]

This trial is based on real world data (which is good) but it's not as reliable as a real head to head trial, a randomized trial

[CousinGrandpa]

Way to go - Dr Neal Shore and the Carolina Urologic Cancer Center!

[Fonske]

Thanks for sharing 👍👍👍