Real-World Data for Darolutamide vs Abiraterone Triplet Therapy in mHSPC

Alicia Morgans, MD, MPH, discusses findings from ARAAT, a real-world analysis comparing darolutamide (Nubeqa) with abiraterone (Zytiga) when each is added to an androgen deprivation therapy (ADT) and docetaxel (Taxotere) backbone in metastatic hormone-sensitive prostate cancer (mHSPC).

Morgans, a genitourinary medical oncologist at Dana-Farber Cancer Institute, explains that the analysis was designed to assess whether these 2 triplet regimens differ in a real-world population. The goal, she explains, was to identify any differences between the regimens that could matter for patients over the course of treatment. Investigators examined outcomes including cancer control and time to next therapy. Morgans notes that these measures can be meaningful because they reflect how long patients are able to stay on treatment before they need something else.

According to Morgans, darolutamide was associated with a longer time to cancer progression and a longer time to next treatment compared with abiraterone. The analysis also suggested that darolutamide may provide better cancer control in the triplet setting.

She highlights why these findings are useful. Darolutamide is a steroid-free option for patients receiving triplet therapy, and Morgans says it might be a good option for patients for 2 reasons. First, it offers ease of use, because prednisone does not need to be added to the regimen. Second, the ARAAT data suggest that darolutamide can control the cancer for a longer period of time before progression.

Morgans also places the results in context. Looking at the study as a whole, she says it shows that excellent cancer control can be achieved with darolutamide and that darolutamide may be superior to abiraterone within the triplet. She emphasizes, however, that these comparisons come from a non-randomized setting in a real-world data analysis, rather than from a randomized trial.

This discussion offers a focused look at real-world effectiveness data for darolutamide and abiraterone used in combination with ADT and docetaxel in mHSPC. Morgans covers the outcomes the ARAAT analysis measured, including time to cancer progression and time to next treatment, the practical advantage of a triplet regimen that does not require prednisone, and the limitations that come with interpreting non-randomized, real-world evidence when comparing these 2 agents.