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ASCO 2023: Real-World Comparison of Darolutamide, Enzalutamide, and Apalutamide in Nonmetastatic Prostate Cancer

By: Amanda E. Ruffino, BA
Posted: Thursday, June 29, 2023

Alicia K. Morgans, MD, MPH, of Dana-Farber Cancer Institute, Boston, and colleagues compared the real-world use, outcomes, and adverse events of darolutamide, enzalutamide, and apalutamide in patients with nonmetastatic castration-resistant prostate cancer. Presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 5097), their findings based on a retrospective chart review cohort study indicate that darolutamide had lower percentages of patients discontinuing treatment, disease progression to metastasis, and adverse events compared with enzalutamide and apalutamide.

The study focused on 870 eligible patients with nonmetastatic castration-resistant prostate cancer who initiated the first androgen receptor inhibitor treatment between August 2019 and March 2022. The cohort included 362 patients given darolutamide, 382 given enzalutamide, and 126 given apalutamide. The baseline characteristics—age, prostate-specific antigen doubling time, and follow-up duration—were similar across the three groups.

The results revealed that 30.4% of patients given darolutamide discontinued treatment, whereas the percentages for those receiving enzalutamide and apalutamide were 40.8% and 46.0%, respectively. Similarly, 17.7% of patients given darolutamide experienced disease progression to metastasis, whereas the rates for those taking enzalutamide and apalutamide were 28.3% and 27.8%, respectively.

In terms of adverse events associated with the three androgen receptor inhibitors, darolutamide was linked to adverse events less often than enzalutamide or apalutamide. Specifically, 24.9% of patients on darolutamide reported adverse events, whereas the percentages for enzalutamide and apalutamide were 29.3% and 30.2%, respectively.

“This study confirms darolutamide’s strong efficacy and favorable tolerability profile in a real-world setting,” the investigators concluded. “The longer treatment duration seen with darolutamide may be associated with a lower risk of progression to metastatic castration-resistance prostate cancer versus enzalutamide/apalutamide.”

Disclosure: For full disclosures of the study authors, visit

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