Oncology · 2 h ago
ARI Treatment Associated With Longer Survival Than Abiraterone in Metastatic Prostate Cancer
A retrospective US cohort study of 3,404 patients with metastatic hormone-sensitive prostate cancer found longer overall survival among patients treated with apalutamide or enzalutamide than among those treated with abiraterone. The authors caution that observational findings cannot establish which treatment is superior; a randomized trial is needed.
- Cohort included 3,404 patients with metastatic hormone-sensitive disease.
- ARI use was associated with longer overall survival than abiraterone.
- Observational findings do not establish a causal treatment advantage.
- Authors say a randomized trial is needed.
Researchers used data from the Flatiron Health electronic health record database to compare outcomes among patients with metastatic hormone-sensitive prostate cancer who received abiraterone, an androgen synthesis inhibitor, or the androgen receptor inhibitors apalutamide or enzalutamide. The retrospective cohort included 3,404 patients diagnosed between February 2013 and April 2024; patients with prior docetaxel treatment were excluded. Median follow-up was 25.6 months. The primary outcome was overall survival from diagnosis.
After inverse probability weighting, androgen receptor inhibitor treatment was associated with longer median overall survival than abiraterone: 67.9 months versus 57.2 months (hazard ratio, 0.74; 95% CI, 0.64-0.87; P<.001). The association was similar in sensitivity analyses, including one restricted to patients with index dates on or after December 16, 2019.
The findings may inform discussions about treatment selection, but they do not establish a causal survival benefit. Treatment was not randomized, and the authors note that real-world results have differed across database populations. The study included data from US community and academic practices and excluded patients who had received docetaxel. The authors say a randomized clinical trial is needed to definitively compare these treatment approaches.
In practice
For patients with metastatic hormone-sensitive prostate cancer resembling this US cohort, treatment with apalutamide or enzalutamide was associated with longer overall survival than treatment with abiraterone. This retrospective comparison does not show that ARIs cause better survival, and treatment allocation may have been influenced by factors not fully captured in the data. The results may inform treatment discussions but do not establish a preferred option; the authors say a randomized trial is needed for a definitive comparison.
AI-generated clinical interpretation · Not editor-reviewed
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JAMA Network Open: Androgen Synthesis Inhibitors vs Androgen Receptor Inhibitors and Survival in Metastatic Hormone-Sensitive Prostate Cancer ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.