Time to Discontinuation on Darolutamide Longer in nmCRPC


Alicia K. Morgans, MD, MPH, discusses real-world evidence the shows patients with non-metastatic castration resistant prostate cancer on darolutamide have a longer time till discontinuation when compared with enzalutamide and apalutamide.

Alicia K. Morgans, MD, MPH, genitourinary medical oncologist and the medical director of the Survivorship Program at the Dana-Farber Cancer Institute in Boston, Massachusetts, discusses the rate of adverse events [AEs] and reasons for treatment discontinuation seen in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) on a real-world analysis of patient data.

These data come from the Comparative Real-world Evidence of Darolutamide (Nubeqa), Enzalutamide (Xtandi), and Apalutamide (Erleada) for Nonmetastatic Castration-Resistant Prostate Cancer Patients in the United States (DEAR) study, which were presented at the 2023 American Society of Clinical Annual Meeting. Patients nmCRPC who were given darolutamide showed a longer time to treatment discontinuation when compared with patients on enzalutamide and apalutamide.

To evaluate these patients, they looked at the proportion of patients that discontinued their first androgen receptor inhibitor treatment, along with the reasons for discontinuation, and if these patients progressed to mCRPC. Further, they wanted to find the time in between discontinuation of treatment or progression to metastatic disease.

Overall, 870 men with non-mCRPC were included in the study with 362 who received darolutamide, 382 given enzalutamide, and 126 were on apalutamide. Patients who discontinued their initial treatment made up 30.4% of patients on darolutamide vs 40.8% of patients on enzalutamide and 46.0% of patients on apalutamide.

Here, Morgans discusses the real-world data found between patients on these therapies and how darolutamide was numerically superior to treatment with either enzalutamide or apalutamide.


0:08 | The rate of [AEs] was somewhat lower, numerically, among patients treated with darolutamide, in terms of a reason for discontinuation, than it was for enzalutamide and apalutamide, again as a reason for discontinuation. So, this doesn't characterize and quantify every single [AE] that was happening to these patients, but in the context of discontinuation these rates were numerically different. There were also lower rates in terms of reasons for discontinuation of progression to mCRPC for patients who were treated with darolutamide when compared with those patients treated with enzalutamide and apalutamide. This is a numeric comparison, and there was not a statistical test performed to actually formally compare these though.

0:50 | Other reasons for discontinuation included switching to another androgen receptor signaling inhibitor or cost reimbursement factors, and then a bundle of other things that were just sort of characterized as other or unknown. When we looked, additionally, at this progression to mCRPC we saw that the proportion of patients with progression to mCRPC was lower among patients treated with darolutamide than among patients treated with apalutamide or enzalutamide. And this was assessed in a formal statistical comparison in both unadjusted and adjusted analyses.

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