The following is a summary of “Real-World Study On Darolutamide, Enzalutamide, And Apalutamide For Nonmetastatic Castration-Resistant Prostate Cancer Patients Using A Urology Network In The United States,” published in the April 2023 issue of Urology by Shore et al.

The use of second-generation androgen receptor inhibitors (ARIs) has been pivotal for nonmetastatic castration-resistant prostate cancer (nmCRPC) patients due to their efficacy in prolonging overall survival and metastasis-free survival. However, real-world (RW) data concerning different ARIs’ outcomes are limited. The DEAR study is the first to analyze RW utilization and outcomes of darolutamide (Daro), enzalutamide (Enza), and apalutamide (APA) in nmCRPC patients using a single data source.

Conducted through a retrospective chart review from the Precision Point Specialty network of US urology practices, this study included nmCRPC patients initiating their first ARI treatment between August 2019 and March 2022, stratified into daro, Enza, or apa cohorts. The interim report assessed discontinuation rates, progression to metastatic CRPC (mCRPC), and estimated probabilities of discontinuation/progression at various time points using Kaplan-Meier estimates.

Of the 666 patients included (daro/enza/apa, n=276/280/110), baseline characteristics like median age, race, and prostate-specific antigen doubling time were comparable across cohorts. Notably, fewer patients discontinued treatment (27.9%) or progressed to mCRPC (18.1%) in the daro cohort compared to enza (37.9%/28.9%) or APA (45.5%/25.5%), respectively. Overall, Daro showed numerically lower estimated probabilities of discontinuation/progression compared to Enza or Apa.

This interim analysis suggests a favorable trend in daro patients, with lower rates of treatment discontinuation and mCRPC progression compared to enza or apa, despite similar baseline characteristics among the cohorts. These findings offer valuable real-world insights into the usage and outcomes of different ARIs in nmCRPC patients, providing essential information for optimizing treatment strategies in clinical practice.

Source: auajournals.org/doi/10.1097/JU.0000000000003257.13