In a nutshell
The study compared outcomes of apalutamide (A; Erleada), darolutamide (D; Nubeqa), and enzalutamide (E; Xtandi) in treating nonmetastatic castration-resistant prostate cancer (nmCRPC). The authors found that A and E had better metastasis-free survival (MFS) compared to D.
Some background
Men with CRPC fail to respond to androgen deprivation therapy (ADT). ADT blocks the male hormone testosterone and prevents PC cells’ growth. NmCRPC is cancer that has not yet spread to distant organs or tissues. It commonly becomes metastatic within 5 years. A, D, and E delayed metastasis and improved MFS in clinical trials. MFS means how long patients survive without metastasis after treatment initiation. However, comparisons between the effectiveness of these 3 drugs are lacking.
Methods & findings
The authors extracted data from 3 trials reporting effects of A, D, and E on a total 4117 patients with nmCRPC. Patients had received either of A/D/E or placebo (a drug with no effects).
Patients on placebo had 68% higher chances of metastasis compared to the A/D/E group. Patients on D had a 27% higher risk of metastasis compared to A and a 29% higher risk compared to E. Both A and E groups had similar risks of metastasis.
Prostate-specific antigen (PSA) is a protein made by the prostate gland. Progression or increase in PSA levels indicates advance in PC. Patients on D had a 54% higher risk of PSA progression compared to A and a 46% higher risk compared to E. Both A and E groups had similar PSA progression rates.
No differences in overall survival were seen between the A, E, and D groups.
The bottom line
The study concluded that survival without metastasis was similar between A and E, but higher compared to D in treating patients with nmCRPC.
The fine print
This study was a meta-analysis, meaning that it compiled and reanalyzed data from multiple trials. The drugs were not compared directly. Further controlled studies are needed to evaluate the compared effectiveness of the 3 drugs.
Published By :
Urologic oncology
Date :
Jun 28, 2020
