Darolutamide & time to treatment discontinuation in nmCRPC

[pca2004]

Further to the recent Apalutamide thred, we now have [1]:

"A real-world analysis of the androgen receptor inhibitors (ARIs) darolutamide (Nubeqa), enzalutamide (Xtandi), and apalutamide (Erleada) found that darolutamide had a longer time to treatment discontinuation and longer time to progression to metastatic castration-resistant prostate cancer (mCRPC) vs enzalutamide and apalutamide.

Oddly, there is no mention of months in the article.

"The proportion of patients who discontinued initial ARI treatment was 30.4% for darolutamide compared with 40.8% for enzalutamide and 46.0% for apalutamide.“

"A Cox proportional hazards model adjusting for baseline factors showed that patients on darolutamide had a 27.4% lower risk of discontinuing initial ARI treatment over time compared with enzalutamide and a 39.1% lower risk compared with apalutamide,” Morgans said.

"AEs were the most common reason for nmCRPC treatment discontinuation, occurring in 10.2% of patients receiving darolutamide, 14.4% of patients receiving enzalutamide, and 15.1% of patients receiving apalutamide.

"The investigators also reported that the proportion of patients who progressed to mCRPC was lower with darolutamide (17.7%) compared with enzalutamide (28.3%) and apalutamide (27.8%). In addition, a Cox proportional hazards model that adjusted for baseline factors indicated that patients receiving darolutamide had a 40.6% lower risk of progression to mCRPC over time vs enzalutamide and a 35.3% lower risk of progression to mCRPC vs apalutamide.

"In all, 24.9% patients receiving darolutamide experienced any AE vs 29.3% and 30.2% of patients receiving enzalutamide and apalutamide, respectively."

"Reference.

"Morgans AK, Shore ND, Khan N, et al. Comparative real-world (RW) evidence on darolutamide (Daro), enzalutamide (Enza), and apalutamide (Apa) for patients (Pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) in the United States: DEAR. J Clin Oncol. 2023;41(suppl 16):5097. doi:10.1200/JCO.2023.41.16_suppl.5097"

I can't access that paper.

-Patrick

[1] urologytimes.com/view/darol...

[Ramp7]

After my meeting with Dr. Denmeade, if and when my BAT protocol stalls, I'll do darolutamide for a period of time. Then back to BAT. Denmeade said more tests are needed to truly understand the process.

[PCaWarrior in reply to Ramp7]

ExBAT clinicaltrials.gov/ct2/show...

Estimated completion in 10 months.

[Ramp7 in reply to PCaWarrior]

Curious to see results. Also keep in mind they are employing Cipionate Testosterone which washes out slower than Propionate. Some think the rapid decline in Testosterone is also a feature worth considering. I'm using propionate.

[MateoBeach]

The superiority of darolutamide over apalutamide and enzalutamide is further confirmed but not surprising. As I’ve previously noted it it less susceptible to loss of function or antagonist-agonist mutations. And the SE profile. Certainly better with no blood brain barrier penetration. However, abiraterone +p is still an excellent choice for long term advanced androgen treatment and not compared here. Weird that they do not report months nor provide a waterfall depicting of times to failure.

Full disclosure: I use darolutamide at half doses for just one week when starting my “castrate T” month of my long cycle BAT program with Orgovyx. Undetectable PSA on BAT now for 2.5 years. Just sayin’.

[Ramp7 in reply to MateoBeach]

Currently staying with the typical 4 week cycle. Very curious as to reasons behind a longer cycle. Just thinking of QOL improvement is motivation.

[PCaWarrior]

targetedonc.com/view/darolu...