Apalutamide as first-line treatment, real-world data

[Maxone73]

Because sometimes it's nice to know the actual outcomes in day to day clinical practice.

A retrospective real-world study analyzed the effectiveness of apalutamide (APA) combined with androgen-deprivation therapy (ADT) as a first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC).

Using data from nearly 5,000 patients, the study showed that APA+ADT outperformed enzalutamide, abiraterone, and ADT alone in overall survival (OS), time to castration resistance (TTCR), and PSA response. At 24 months, OS was 66% for APA+ADT, compared to 55% for enzalutamide+ADT and 59% for abiraterone+ADT.

However (my usual luck) the study lacks a comparison with darolutamide, which is becoming a key standard of care in this setting, limiting its relevance in the evolving treatment landscape. This omission highlights the need for future research (hint hint!) to include darolutamide for a comprehensive evaluation of ARSI options.

prostatewarriors.com/2025/0...

[Peppertree602]

how long was treatment?

[Maxone73 in reply to Peppertree602]

it's not specified but it's retrospective so to have uniform results they have considered every parameter at 24 months

[Peppertree602 in reply to Maxone73]

Ok thanks

[allmo]

Is this study involving de novo high volume mHSPC patients or some random mix of de novo patients?

[Maxone73 in reply to allmo]

Hi! It was not specified, but I think they might have the raw data for public use.

[allmo]

"Apalutamide showed a statistically significant improvement in 24-month OS compared to enzalutamide in mCSPC patients, with rates of 87.6% vs 84.6%."