Audrey Sternberg

 Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, Primo Nery Lara, Jr., MD, shares his expert insight on the latest developments with immunotherapy (IO), targeted agents, and risk stratification in the treatment paradigm for renal cell carcinoma (RCC).

Active Surveillance and Cytoreductive Approaches

In the treatment of clear cell RCC, Lara reviewed a treatment decision pathway that involves risk stratification according to International Metastatic RCC Database Consortium (IMDC) criteria and assessment by a multidisciplinary tumor board at the forefront of any good treatment plan.

“The question that the tumor board tackles first is whether this individual with metastatic RCC is a candidate for active surveillance. There is a subset of patients with advanced kidney cancer for whom you could watch [and wait] until such time comes when you do need to treat them with systemic therapies that have adverse effects,” Lara said. “The question of who is a candidate for active surveillance is hard to answer because this is a bedside, gut decision.”

He turned to data from a phase 2 prospective trial of 52 patients that showed surveillance could be a viable treatment option for certain patients with metastatic RCC.

 Median time to treatment initiation was 14.9 months (95% CI, 10.6-25.0) overall, with shortened surveillance associated with adverse risk factors (

 = .0403) and higher numbers of metastatic disease sites (

“The other question that tumor boards often tackle is whether a cytoreductive approach is necessary,” Lara said. “Most favorable-risk patients and some of those with intermediate-risk disease remain candidates for a cytoreductive nephrectomy, especially those with large and/or symptomatic primary tumors and a low burden of metastatic disease.”

Lara turned to 2 recently reported trials that showed noninferiority of systemic therapy approaches vs systemic therapy plus nephrectomy in this setting. In the phase 3 CARMENA trial (NCT00930033), sunitinib (Sutent) alone was found to produce noninferior overall survival (OS) vs sunitinib plus nephrectomy in patients with intermediate- or poor-risk disease (HR, 0.89; 95% CI, 0.71-1.10).

 In the phase 3 SURTIME trial (NCT01099423), deferred cytoreductive nephrectomy after 3 cycles of sunitinib improved OS vs immediate nephrectomy (HR, 0.57; 95% CI, 0.34-0.95; 

 He noted that decisions must be individualized according to risk.

“Many intermediate- and most poor-risk patients should start on systemic therapy first,” Lara said.

As for metastasectomy, Lara said patients with a good performance status, isolated or oligometastatic disease, a disease-free interval of 2 years following nephrectomy, no lymph node involvement, or lung-only disease may benefit from local ablative approaches.

Therapy With Combination Regimens in 2022

The next aspect of the treatment decision making is systemic therapy selection, a choice which Lara said hinges on whether the patient is eligible to receive IO therapy.

“The standard of care in 2022 for metastatic kidney cancer is immunotherapy-based combination therapy,” Lara said. “Most of these patients should be considered for combination therapies, and there are several combinations that we would offer depending on their risk group.”

After patients are deemed eligible for an IO-based combination, the clinicians should again turn to risk stratification to select the most appropriate regimen for individual patients.

In the phase 3 CheckMate 214 trial (NCT02231749) that led to the approval of nivolumab (Opdivo) plus ipilimumab (Yervoy) in patients with frontline metastatic RCC, 4-year follow-up data show advantage of the combination vs sunitinib in terms of OS for the intention-to-treat population (HR, 0.69; 95% CI, 0.59-0.81) and the intermediate/poor-risk subgroup (HR, 0.65; 95% CI, 0.54-0.78).

However, Lara noted that patients with favorable-risk disease failed to derive an OS benefit (HR, 0.93; 0.62-1.40).

“[This combination] would be great for intermediate- and poor-risk disease, not so much for favorable risk where it was no better than sunitinib,” Lara said

The next trial reviewed was the pivotal phase 3 KEYNOTE-426 trial (NCT02853331) of pembrolizumab (Keytruda) plus axitinib (Inlyta) vs sunitinib. Updated data at the 42-month follow-up showed sustained OS benefit of the combination (HR, 0.73; 95% CI, 0.60-0.88). Similar to results from CheckMate 214, most of the benefit with pembrolizumab/axitinib was isolated to patients with intermediate/poor-risk disease.

Moving on the phase 3 CheckMate 9ER trial (NCT03141177) that supported the approval of cabozantinib (Cabometyx) and nivolumab in this setting, Lara spotlighted OS results which showed a 40% reduction in the risk of death with the combination vs sunitinib (HR, 0.60; 98.89% CI, 0.40-0.89; 

Finally, the phase 3 CLEAR trial (NCT02811861) showed an advantage of lenvatinib (Lenvima) plus pembrolizumab vs sunitinib in terms of progression-free survival (PFS; HR, 0.39; 95% CI, 0.32-0.49; 

 <.001) and OS (HR, 0.66; 95% CI, 0.49-0.88; 

Comparing results of CLEAR with the previously reviewed trials, Lara said “results superficially seem to be better if you look at the complete response rate, the median PFS, and [OS]. But you must note that this trial had the lowest percentage of poor-risk patients [vs other pivotal trials reviewed], which will drive a lot of the of the results of these trials.”

For patients who are ineligible for IO agents or VEGFR tyrosine kinase inhibitors (TKIs), treating clinicians must consider single-agent therapies in the setting of frontline RCC.

“Those who have active autoimmune disease should probably not risk [treatment with] a checkpoint inhibitor. Those with a history of solid organ transplantation and those on supraphysiologic corticosteroids are not your best candidates, or those with illnesses that require chronic immune suppressive therapy,” Lara said. “Sometimes there will be a patient who will have a personal preference [to avoid intravenous] therapy or who doesn’t want to go to your clinic because it is too far to drive; they’re not eligible for immunotherapy for those practical reasons.”

For these patients who are intolerant to or who refuse IO, they may receive therapy with a single-agent VEGFR TKI. In patients with bone-only metastases, cabozantinib monotherapy may be preferential based on results of the phase 1 CABOSUN trial (NCT02496208), which showed a PFS advantage vs sunitinib in the indicated patient subset (0.54; 95% CI, 0.31-0.95).

 Similarly, Lara said he would use single-agent cabozantinib for patients with non–clear cell papillary RCC and perhaps for those with favorable-risk disease.

“Favorable-risk patients treated with pembrolizumab plus axitinib didn’t seem to benefit from that doublet, so maybe those patients ought to get a VEGFR TKI and then reserved immunotherapy for later,” Lara said.

Conversely, some patients may only be suitable for treatment with single-agent immunotherapy. “For those who are ineligible for or refuse to receive a VEGFR TKI–containing combination or those patients who [want to avoid] ipilimumab toxicities, single-agent checkpoint inhibitors are reasonable.”

Lara is director of the University of California Davis (UC Davis) Comprehensive Cancer Center as well as Codman-Radke Endowed Chair in Cancer Research and executive associate dean for Cancer Programs at UC Davis Health in Sacramento.

Rini BI, Dorff TB, Elson P, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. 

. 2016;17(9):1317-1324. doi:10.1016/S1470-2045(16)30196-6

Méjean A, Ravaud A, Thezenas S, et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. 

. 2018;379(5):417-427. doi:10.1056/NEJMoa1803675

Bex A, Mulders P, Jewett M, et al. Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial. 

. 2019;5(2):164-170. doi:10.1001/jamaoncol.2018.5543

FDA approves nivolumab plus ipilimumab combination for intermediate or poor-risk advanced renal cell carcinoma. FDA. April 16, 2018. Accessed March 14, 2022. https://bit.ly/3Jji5nm

Albiges L, Tannir NM, Burotto M, et al. Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial. 

. 2020;5(6):e001079. doi:10.1136/esmoopen-2020-001079

Rini BI, Plimack ER, Stus V, et al. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma (ccRCC): Results from 42-month follow-up of KEYNOTE-426. 

. 2021;39(suppl 15):4500. doi:10.1200/JCO.2021.39.15_suppl.4500

FDA approves nivolumab plus cabozantinib for advanced renal cell carcinoma. FDA. January 22, 2021. Accessed March 14, 2022. https://bit.ly/34Gb3K4

Motzer R, Alekseev B, Rha SY, et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. 

. 2021;384(14):1289-1300. doi:10.1056/NEJMoa2035716

Choueiri TK, Halabi S, Sanford BL, et al. Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk: the Alliance A031203 CABOSUN trial. 

. 2017;35(6):591-597. doi:10.1200/JCO.2016.70.7398

Articles

“The question of who is a candidate for active surveillance is hard to answer because this is a bedside, gut decision," says Primo Nery Lara, Jr, MD.

Dr. Lara reviews the evolving systemic therapy paradigm in renal cell carcinoma 

Findings from the placebo-controlled phase 3 ARASENS trial showed that adding darolutamide (Nubeqa) to standard androgen deprivation therapy (ADT) and docetaxel boosted overall survival (OS) versus ADT/docetaxel alone in patients with metastatic castration-sensitive prostate cancer (CSPC).

Results reported at the 2022 Genitourinary Cancers Symposium

 showed that at a median follow-up of 43.7 months for darolutamide plus ADT/docetaxel and 42.4 months with placebo plus ADT/docetaxel, the active therapy resulted in a 32.5% reduction in the risk of death (HR 0.68, 95% CI 0.57–0.80; 

“Darolutamide improved overall survival despite a high rate of subsequent life prolonging systemic therapies in the placebo group,” Matthew R. Smith, MD, PhD, director of the Genitourinary Malignancies Program at Massachusetts General Hospital and professor of medicine at Harvard Medical School, said during a presentation of the data. “The overall survival benefit for darolutamide was consistent across prespecified subgroups.”

Darolutamide is a structurally distinct and highly potent androgen receptor (AR) inhibitor that was previously approved to treat patients with castration-resistant prostate cancer (CRPC) in the nonmetastatic setting based on results of the phase 3 ARAMIS trial (NCT02200614).

 Data from the study showed a statistically significant improvement in metastasis-free survival with the agent against matched placebo.

In ARASENS (NCT02799602), patients with cytologically confirmed metastatic adenocarcinoma of the prostate were eligible for the trial. All participants needed to be candidates for ADT and docetaxel, have an ECOG performance status of 0 or 1, and have adequate organ function.

Patients were randomized 1:1 to either 600 mg of daily darolutamide (n = 651) or matched placebo (n = 655) plus ADT/docetaxel. Factors for stratification included extent of disease (M1b/b/c) and alkaline phosphatase (ALP) levels. The primary end point was OS with secondary outcome measures of time to CRPC, time to pain progression, time for first symptomatic skeletal event (SSE), time to initiation of subsequent systemic antineoplastic therapy, and safety.

Patient characteristics were well balanced between the 2 groups. The median age was 67 years for both the darolutamide and placebo groups and most patients had a Gleason score of 8 or greater (77.6% vs 78.9%, respectively) and M1 stage (85.7% vs 86.5%) at initial diagnosis. At initial screening, patients in both groups were most likely to have M1b stage disease (79.4% vs 79.5%) and ALP levels equal to or above the upper limit of normal (55.5% each).

Median OS in the darolutamide arm was not estimable (NE; 95% CI, NE-NE) vs 48.9 months (95% CI, 44.4-NE) with placebo. Rates of OS at 48 months were 62.7% and 50.4%, respectively. The effect of active therapy was consistent across patient subgroups, including by ALP level below (HR, 0.64; 95% CI, 0.46-0.88) or above the upper limit of normal (HR, 0.69; 95% CI, 0.56-0.85), and by either de novo (HR, 0.71; 95% CI, 0.59-0.85) or recurrent (HR, 0.61; 95% CI, 0.35-1.05) metastatic disease status.

Moreover, darolutamide was associated with superior secondary outcomes despite patients in this arm receiving fewer subsequent life-prolonging systemic antineoplastic therapies (56.8%) vs the placebo arm (75.6%). Common subsequent therapies included abiraterone acetate (35.6% vs 46.9%), enzalutamide (Xtandi; 15.2% vs 27.5%), cabazitaxel (Jevtana; 18.1% vs 18.0%), and docetaxel (14.6% vs 18.0%). Notably, 66% of patients in the placebo arm went on to receive life-prolonging therapy with an AR pathway inhibitor. Time to first subsequent antineoplastic therapy was NE (95% CI, NE-NE) in the active therapy arm vs 25.3 months (95% CI, 23.1-28.8) in the placebo group (HR, 0.39; 95% CI, 0.33-0.46; 

A significant delay in time to castration-resistant disease was noted in the darolutamide vs placebo groups, at NE (95% CI, NE-NE) vs 19.1 months (95% CI, 16.5-21.8), respectively (HR, 0.36; 95% CI, 0.30-0.42; 

 <.001). Darolutamide was also associated with increased time to pain progression at NE (95% CI, 30.5-NE) vs 27.5 months (95% CI, 22.0-36.1) with placebo (HR, 0.79; 95% CI, 0.66-0.95; 

 = .01). Time to first SSE was NE in both arms, but statistically significant benefit with the darolutamide combination was noted (HR, 0.71; 95% CI, 0.54-0.94; 

Rates of treatment-emergent adverse events (AEs) were similar between arms, at 99.5% with the darolutamide regimen and 98.9% with placebo. “Consistent with prior clinical experience in other settings, darolutamide had a favorable safety profile. The rates of any treatment-emergent adverse event, serious adverse event, and adverse events leading to permanent discontinuation of study treatment were similar between the darolutamide and the placebo groups,” Smith said.

Grade 3/4 AEs occurring with darolutamide and placebo included neutropenia (33.7% vs 34.2%, respectively), febrile neutropenia (7.8% vs 7.4%), hypertension (6.4% vs 3.2%), and anemia (4.8% vs 5.1%). After adjusting for differences in drug exposure, the was no difference in the occurrence of AEs of special interest for AR pathway inhibitors between groups, including events such as fatigue, bone fractures, rash, falls, hypertension, and cardiac disorders.

“Based on the results of ARASENS, we conclude that darolutamide in combination with ADT and docetaxel should become a new standard of care for the treatment of patients with [metastatic CSPC],” Smith concluded.

1. Smith MR, Hussain MHA, Saad F, et al. Overall survival with darolutamide versus placebo in combination with androgen-deprivation therapy and docetaxel for metastatic hormone-sensitive prostate cancer in the phase 3 ARASENS trial. J Clin Oncol. 2022;40(suppl 6):abstr 13. doi: 10.1200/JCO.2022.40.6_suppl.013

2. Smith MR, Hussain MHA, Saad F, et al. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. 

. Published online February 17, 2022. doi: 10.1056/NEJMoa2119115

3. FDA approves darolutamide for non-metastatic castration-resistant prostate cancer. FDA. July 30, 2019. Accessed February 17, 2022. https://bit.ly/3JDxm26

“Darolutamide improved overall survival despite a high rate of subsequent life prolonging systemic therapies in the placebo group,” said Matthew R. Smith, MD, PhD, lead author of the phase 3 ARASENS trial. 

Adding darolutamide to standard care improves survival in metastatic castration-sensitive prostate cancer

Combining dose-escalated radiotherapy with short-term androgen deprivation (STAD) significantly improved PSA failure, metastases, and cancer-related death rates in men with intermediate-risk prostate cancer; however, a similar benefit was not observed with overall survival (OS), according to findings from the phase 3 trial RTOG 0815 trial shared during the 2021 ASTRO Annual Meeting.

“Patients with intermediate-risk prostate cancer we know benefit from both escalation of radiotherapy dose as well as from the addition of androgen suppression. Technically, we still don’t know if we need both,” Daniel Krauss, MD, of the Rose Cancer Treatment Center in Royal Oak, Michigan, said during a presentation of the data. “Previous results have been confounded by heterogenous inclusions criteria that have frequently included high-risk in addition to intermediate-risk patients and noncontemporary radiotherapy techniques.”

The trial aimed to determine if addition of STAD, defined as 6 months of total androgen suppression with a luteinizing hormone-releasing hormone agonist and an antiandrogen, would result in OS improvement in patients with intermediate-risk prostate cancer who were being treated with definitive, dose-escalated radiotherapy.

Eligibility criteria included nonmetastatic, intermediate-risk prostate cancer defined as the presence of 1 or more of the following factors: biopsy with a Gleason score of 7, pretreatment PSA level above 10 ng/mL and up to 20 ng/mL, or clinical stage T2b-T2c disease. Patients positive for all 3 baselines factors who had more than 50% of biopsy cores positive were not eligible for treatment. Stratification was based on number of risk features, comorbidity status, and radiotherapy modality.

Patients (N = 1538) were randomized to dose-escalated radiotherapy alone—which consisted of external beam radiation therapy (EBRT) at 79.2 Gy, EBRT plus a low-dose rate brachytherapy boost, or EBRT plus a high-dose rate brachytherapy boost—or with STAD. The primary end point was OS designed to detect a 3% improvement at 5 years with a 1-side significance level of 0.025 and 85% power, which translates to a 34% reduction in the annual death rate (HR, 0.66). Secondary end points included biochemical failure, local failure, distant metastases, prostate cancer death, non-prostate cancer death, and initiation of salvage therapy.

Patient characteristics were well balanced between the 2 arms with a median patient age of 68 (interquartile range [IQR], 63-72 years), most being White (75%), and having a Zubrod performance status of 0 or 1 (99.9%). Two-thirds of patients each (67%) had 1 intermediate risk factor and an ACE-27 score of 2 or lower. Radiotherapy modality in most cases (89%) was EBRT alone. Baseline PSA was 8.1 ng/mL (range, 5.1-10.6 ng/mL) on average, most patients (92%) had a Gleason score of 7, and nonpalpable T1 disease occurred in the majority of cases (63%).

In all evaluable patients (n = 1492), the median follow-up was 6.2 years. The only factor associated with an increased risk of acute adverse effects (AEs) was being treated in the radiotherapy plus STAD arm (odds ratio [OR], 8.7; 95% CI, 6.85-11.11; 

“This is largely driven by the known and anticipated [adverse] effects of endocrine therapy for prostate cancer, [such as] endocrine, sexual and reproductive, metabolic/laboratory domains,” Krauss said. “There was a slight increased risk of experiencing a cardiac adverse event [1% vs 0.4%] but the overall rate was low and there was no difference in the rates of [gastrointestinal or genitourinary] adverse events based on whether or not patients received androgen deprivation.”

Of note, Krauss said there was no increased rate of late adverse events associated with androgen deprivation.

Five-year rates of OS were 90% for patients treated with radiotherapy alone versus 91% for those receiving radiotherapy plus STAD. At 8 years, corresponding rates were 79% and 84% with further follow-up failing to show a statistically significant difference in outcomes (

In terms of PSA failure, rates were higher for patients on radiotherapy alone at 5 years at 14% vs 8% for those in the radiotherapy/androgen deprivation arm; at 8 years, those rates were 21% and 10% (

 <.001). Five- and 8-year rates of distant metastasis in the radiotherapy alone arm were 3.1% and 4.3%, respectively, vs 0.6% and 1.0% (

Initiation of salvage therapy occurred in 6.1% of those in the radiotherapy alone arm at 5 years compared with 4.2% with both modalities. At 8-years the corresponding rates of initiation of salvage therapy were 9.8% and 5.3%, respectively (

Prostate cancer–specific mortality at 5 and 8 years was 0.9% and 1.6%, respectively, in the radiotherapy alone arm; in the androgen deprivation arm, only 1 event was noted overall (

 = .007). No difference was noted for non-prostate cancer–specific mortality (

The investigators looked to stratification factors to try and determine which patients were driving differences in PSA failure and distant metastases rates. They determined that all but a small group of patients with a Gleason score of 2 – 6 (8.24%) benefited from the addition of STAD by both outcome measures.

“There was no difference in the patient-reported outcomes in the EPIC urinary or bowel domains, so the administration of this hormonal therapy comes at the cost of approximately 12 months of detriment in the hormone and sexual function domains that resolve with further follow-up,” Krauss said.

1. Krauss DJ, Karrison TG, Martinez AA, et al. Dose escalated radiotherapy alone or in combination with short-term androgen suppression for intermediate risk prostate cancer: outcomes from the NRG Oncology/RTOG 0815 randomized trial. 

. 2021;111(suppl 3):S1. doi:10.1016/j.ijrobp.2021.07.039

“Patients with intermediate-risk prostate cancer we know benefit from both escalation of radiotherapy dose as well as from the addition of androgen suppression. Technically, we still don’t know if we need both,” said Daniel Krauss, MD.

Dose-escalated RT plus androgen suppression yields mixed outcomes in prostate cancer

Findings from the prospective phase 2 ODEZA trial showed that darolutamide (Nubeqa) was associated with a cognitive function benefit versus enzalutamide (Xtandi) in patients with metastatic castration-resistant prostate cancer (mCRPC).1

The findings, which were shared during the 2021 ESMO Congress, specifically showed that episodic memory by computerized cognitive assessment was significantly improved in patients who received darolutamide compared with those treated with enzalutamide. Darolutamide was associated with better verbal learning and verbal memory compared with enzalutamide, with nonsignificant trends towards executive function also noted.

“The favorable effect of darolutamide on episodic memory over enzalutamide was observed for both the acquisition of new information, as well as for the recall of that information after a brief delay,” the authors of the poster, who were led by Emeline Colomba, MD, of the Department of Cancer Medicine at Institut Gustave Roussy of University of Paris Saclay in Villejuif, France, wrote.

Low blood-brain barrier penetrance is a known benefit of darolutamide vs other antiandrogen agents, such as enzalutamide. Results of the ODENZA trial that were previously reported at the 2021 American Society of Clinical Oncology Annual Meeting indicated that numerically more patients reported preferring darolutamide than enzalutamide, although these correlations did not reach statistical significance. Of note, fatigue was a key influencing factor for preference and was reported in 21% of patients receiving darolutamide vs 36% with enzalutamide

Patients with mCRPC (n = 249) were randomized 1:1 to either darolutamide at 1200 mg daily for 12 weeks followed by enzalutamide at 160 mg daily for 12 weeks or the reverse sequence. The current assessment looks at cognitive assessment, a key secondary end point of the study, using computerized tests to determine changes from baseline during each 12-week period.

Criteria for evaluation included detection test (DET) for psychomotor function and an identification test (IDT) for visual attention, which comprised an attention composite score; a working memory, or One Back Test (OBT), and an executive function, or Groton Maze Learning test (GML), which comprised an executive function composite score; and a verbal learning, or International Shopping List test (ISL), and a verbal memory testing, or International Shopping List test–delayed recall (ISRL), comprising a memory composite (episodic memory) score.

Cognitive data were available in 193 patients in total. Effects sizes were considered clinically meaningful at 0.5 or greater.

The memory composite score demonstrated a statistically significant benefit of darolutamide (

<.001), with a least square (LS) mean difference of 0.35 and an effect size of 0.54. Performance on verbal learning by ISL were significantly improved with darolutamide and effects were clinically meaningful, both at the second period (0.62; 

 < .0001). Performance on verbal learning was also better with darolutamide at the second period (0.4; P = .01) and overall (0.29; 

 = .0075), although these effects were less clinically meaningful.

Between darolutamide and enzalutamide, the effect sizes for both the executive function and attention composite scores were 0.15, with LS mean differences of 0.09 and 0.12, respectively (

Overall, investigators noted that composite scores were in line with individual scores and that moderate benefit with darolutamide was noted for episodic memory.

1. Colomba E, Jonas SF, Yymard J-C, et al. Objective computerized cognitive assessment in men with metastatic castrate-resistant prostate cancer (mCRPC) randomly receiving darolutamide or enzalutamide in the ODENZA trial. Presented at: 2021 European Society for Medical Oncology Congress; September 16-21, 2021. Virtual. Abstract 603P.

2. Colomba E, Jonas SF, Yymard J-C, et al. ODENZA: A French prospective, randomized, open-label, multicenter, cross-over phase II trial of preference between darolutamide and enzalutamide in men with asymptomatic or mildly symptomatic metastatic castrate-resistant prostate cancer (CRPC). J Clin Oncol. 2021;39(suppl 15):5046. doi:10.1200/JCO.2021.39.15_suppl.5046

Episodic memory by computerized cognitive assessment was significantly improved in patients who received darolutamide compared with those treated with enzalutamide.

Audrey Sternberg

Articles

Dr. Lara reviews the evolving systemic therapy paradigm in renal cell carcinoma

Adding darolutamide to standard care improves survival in metastatic castration-sensitive prostate cancer

Dose-escalated RT plus androgen suppression yields mixed outcomes in prostate cancer

Darolutamide linked to cognitive benefit over enzalutamide in prostate cancer