Apalutamide Proves More Effective Than Enzalutamide for Patients With mCSPC

A study led by Mehmet Asim Bilen, MD, and presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium demonstrated that when compared with enzalutamide, apalutamide led to improved results for patients with metastatic castration-sensitive prostate cancer (mCSPC).

Previous research showed that in the clinical trial setting, patients treated with androgen receptor signaling inhibitors, which include enzalutamide and apalutamide, experienced improved progression-free survival and overall survival rates. However, Dr. Bilen and colleagues noted a lack of research into real-world treatment effectiveness.

The study evaluated real-world survival for patients with mCSPC in the United States who received enzalutamide or apalutamide treatment.

The retrospective study placed patients into 2 treatment groups according to the earliest initiation of enzalutamide or apalutamide on or after December 16, 2019.

Of the 234 patients in the apalutamide cohort, 59.8% were White and 13.7% were Black. In the enzalutamide cohort, 527 patients received the treatment, with 55.2% being White and 13.1% being Black.

In the apalutamide group, the median time on treatment was 10.9 months across a median observation period of 13.3 months. The enzalutamide group experienced a median time on treatment of 11.1 months across a 14.8-month median observation period.

At 24 months, a higher proportion of patients treated with apalutamide survived when compared with those who received enzalutamide (85.4% vs 73.9%; unadjusted hazard ratio, 0.59; 95% CI, 0.39-0.95; P=.030).

The researchers concluded that following a real-world analysis, more patients treated with apalutamide survived than those treated with enzalutamide.

“While the current study reports unadjusted analyses, future studies adjusting for potential confounding variables should be conducted to confirm these findings in order to inform clinicians on treatment selection for patients with mCSPC,” the researchers wrote.