In a nutshell
The study compared the effectiveness and safety outcomes of androgen-deprivation therapy (ADT) with either apalutamide (Erleada) or darolutamide (Nubeqa) for the treatment of non-metastatic castration-resistant prostate cancer (CRPC). The data showed that apalutamide plus ADT was safe and more effective in improving survival without metastasis and cancer worsening compared to darolutamide plus ADT in these patients.
Some background
Non-metastatic CRPC is an aggressive form of prostate cancer that has not spread beyond the prostate gland but is no longer responsive to hormonal therapy such as androgen-deprivation therapy (ADT) alone. ADT reduces the production of androgens (male sex hormones such as testosterone). Reducing these androgens prevents cancer cell growth.
Apalutamide and darolutamide and are both anti-androgen medications. They block testosterone from reaching PC cells. They are recommended for the treatment of non-metastatic CRPC. Both apalutamide and darolutamide in combination with ADT have been shown to improve clinical outcomes like overall survival and lower the risk of disease progression and spread in men with CRPC. However, comparisons between apalutamide plus ADT and darolutamide plus ADT for the treatment of patients with non-metastatic CRPC are still lacking.
Methods & findings
The authors compared data from 2 studies reporting the effects of apalutamide and darolutamide in combination with ADT in patients with non-metastatic CRPC. Patients had received either of the 2 drugs plus ADT or placebo plus ADT.
Patients who received apalutamide plus ADT had a 98.3% probability of better survival without metastasis (cancer spread) compared to darolutamide plus ADT. Apalutamide plus ADT reduced the risk of metastasis by 30% compared to darolutamide plus ADT.
Patients who received apalutamide plus ADT had a 93.2% probability of better survival without cancer worsening compared to darolutamide plus ADT. Apalutamide plus ADT reduced the risk of cancer worsening by 21% compared to darolutamide plus ADT.
Patients who received apalutamide plus ADT had a 100% probability of survival without prostate-specific antigen (PSA: a protein made by cells of the prostate gland that increases in PC) progression compared to darolutamide plus ADT. Apalutamide plus ADT reduced the risk of PSA progression by 54% compared to darolutamide plus ADT.
No differences in the overall survival and side effects were found between either apalutamide plus ADT or darolutamide plus ADT.
The bottom line
This study concluded that apalutamide plus ADT was safe and was more effective in improving survival without metastasis and cancer worsening compared to darolutamide plus ADT for the treatment of men with non-metastatic CRPC.
The fine print
The study was funded by Janssen, the manufacturers of apalutamide.
Published By :
Advances in therapy
Date :
Nov 19, 2021
