Comparison of Real-World Apalutamide and Enzalutamide Data in mCSPC

Panelists discuss how a recently published retrospective analysis comparing apalutamide and enzalutamide in metastatic castration-sensitive prostate cancer (mCSPC) offers new real-world insight into overall survival outcomes between these two androgen receptor pathway inhibitors. The study suggested a potential overall survival advantage with apalutamide; however, the panel emphasizes that this observation must be interpreted cautiously. Factors such as patient selection, disease burden at baseline, and differences in treatment sequencing or access to subsequent lines of therapy may have influenced the results. These variables often shape survival outcomes more than intrinsic pharmacologic superiority.

Panelists discuss how tolerability and adherence can also contribute to apparent survival differences. Because apalutamide and enzalutamide share similar mechanisms but distinct safety profiles, small variations in adverse-effect management—such as addressing fatigue, falls, or hypertension—can influence treatment duration and consistency. Improved tolerability often correlates with sustained adherence, which in turn may translate into longer survival in real-world populations. The discussion highlights that supportive care, early symptom recognition, and patient education play critical roles in maintaining adherence and maximizing outcomes.

Panelists discuss how the key takeaway for clinicians is to apply these findings as supportive context rather than definitive evidence. Both apalutamide and enzalutamide remain effective and evidence-based first-line options for mCSPC. By focusing on individualized therapy—balancing efficacy, comorbidities, adverse effects, and patient preference—clinicians can ensure that real-world evidence informs personalized, data-driven care without overextending the conclusions of retrospective studies.