Castration-sensitive prostate cancer: add-on abiraterone, apalutamide yield greatest benefit

  • 14 Jan 2021

  • Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Abiraterone acetate and apalutamide when added to androgen deprivation therapy (ADT) may provide the largest OS benefits with relatively low risk for serious adverse event risks in patients with metastatic castration-sensitive prostate cancer.

Why this matters

  • Findings can inform clinical decision-making.
  • A cost-effectiveness analysis is warranted to inform value-based decision-making.

Study design

  • Network meta-analysis of 7 trials comparing 6 treatments (abiraterone acetate, apalutamide, docetaxel, enzalutamide, standard nonsteroidal antiandrogen, and placebo/no treatment) in 7287 patients with metastatic castration-sensitive prostate cancer.
  • Funding: Dyar Memorial Fund; Pharmaceutical Research and Manufacturers of America Foundation.

Key results

  • Median follow-up was 52 months.
  • OS significantly improved (all HRs; 95% CIs) with add-on to ADT of:
    • Abiraterone acetate: 0.61 (0.54-0.70).
    • Apalutamide: 0.67 (0.51-0.89).
    • Docetaxel: 0.79 (0.71-0.89).
  • Radiographic PFS also improved with add-on to ADT of:
    • Enzalutamide: 0.39 (0.30-0.50).
    • Apalutamide: 0.48 (0.39-0.60).
    • Abiraterone acetate: 0.51 (0.45-0.58). 
    • Docetaxel: 0.67 (0.60-0.74).
  • Docetaxel was associated with substantially increased risk for serious adverse events (OR, 23.72; 95% CI, 13.37-45.15), as was abiraterone acetate (OR, 1.42; 95% CI, 1.10-1.83).

Limitations

  • Risk for bias.