Dr. Bilen on survival outcomes with apalutamide vs enzalutamide in mCSPC

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"Overall, our conclusion is, in this real-world analyses, more patients treated with apalutamide survive by 24 months following treatment initiation compared to enzalutamide," says Mehmet Asim Bilen, MD.

In this video, Mehmet Asim Bilen, MD, discusses the background and key findings from the study, “Real-world survival of men with metastatic castration-sensitive prostate cancer (mCSPC) initiated on apalutamide (APA) or enzalutamide (ENZ) in an oncology database: ROME Study,” which was presented at the 2024 ASCO Genitourinary Cancers Symposium in San Francisco, California. Bilen is the director of genitourinary medical oncology at the Winship Cancer Institute of Emory University in Atlanta, Georgia.

Video Transcript:

[In] the last couple of years, how we treat metastatic hormone sensitive prostate cancer changed. A long time ago, we were using ADT monotherapy, but after many landmark phase 3 trials, we know a more aggressive treatment from the beginning has better outcomes, including PFS and OS. Particularly androgen receptor signaling inhibitors, including apalutamide and enzalutamide, show a progression-free and overall survival benefit for patients with metastatic castration-sensitive prostate cancer. But we don't have any data to compare head-to-head which one is more effective. Because of this reason, real-world data can give us some idea, although they are not level 1 randomized phase 3 studies, but still give us some idea when we treat our patients in day-to-day practice. In this analysis, we use FlatIron metastatic prostate cancer registry and focused on patients who receive apalutamide or enzalutamide in the first line metastatic castration sensitive prostate cancer [setting]. Roughly we had 200 patients receive apalutamide and another 500 patients receive enzalutamide. When we look at the outcome, by 24 months, a higher proportion of patients in the apalutamide cohort survived than in the enzalutamide cohort, 85% vs 73.9%. Overall, our conclusion is, in this real-world analyses, more patients treated with apalutamide survive by 24 months following treatment initiation compared to enzalutamide. But this is unadjusted analyses; we are planning to do additional multivariate analyses that control some of the confounding factors. And of course, we also need a prospective trial to answer that question, but I think still this is very helpful data for the whole community.

This transcription has been edited for clarity.

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