TY - JOUR
T1 - Advanced Androgen Blockage in Nonmetastatic Castration-resistant Prostate Cancer
T2 - An Indirect Comparison of Apalutamide and Enzalutamide
AU - Wallis, Christopher J.D.
AU - Chandrasekar, Thenappan
AU - Goldberg, Hanan
AU - Klotz, Laurence
AU - Fleshner, Neil
AU - Satkunasivam, Raj
AU - Klaassen, Zachary
N1 - Publisher Copyright:
© 2018 European Association of Urology
PY - 2018/8
Y1 - 2018/8
N2 - Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have historically had few treatment options. Recently, randomized controlled trials have examined the benefit of apalutamide and enzalutamide in these patients. We sought to perform an indirect treatment comparison using a network meta-analysis approach to compare the relative efficacy and toxicity of these two agents. The primary outcome of this analysis was metastasis-free survival (MFS) while secondary outcomes were time to prostate-specific antigen progression, overall survival, and adverse events. The Bucher technique for indirect comparison was used to compare apalutamide and enzalutamide using the common placebo comparator. We found no evidence of a significant difference in MFS (hazard ratio 1.04, 95% confidence interval 0.78–1.37) between enzalutamide and apalutamide. Similarly, there were no differences for any of the secondary outcomes. While indirect comparisons cannot supplant direct comparative data, this analysis suggests that apalutamide and enzalutamide are similarly effective in delaying metastases for patients with nmCRPC. Patient summary: Historically, there have been few treatment options for prostate cancer patients receiving androgen deprivation therapy who have rising prostate-specific antigen levels without obvious recurrence of cancer. Recent randomized controlled trials demonstrated that treatment with enzalutamide and apalutamide delayed the development of metastatic cancer. This study demonstrates through an indirect comparison that both medications are likely to have similar efficacy and side-effect profiles. Recent data support the use of apalutamide and enzalutamide in nonmetastatic castration-resistant prostate cancer. This analysis demonstrates no significant differences in efficacy and toxicity between these two agents.
AB - Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have historically had few treatment options. Recently, randomized controlled trials have examined the benefit of apalutamide and enzalutamide in these patients. We sought to perform an indirect treatment comparison using a network meta-analysis approach to compare the relative efficacy and toxicity of these two agents. The primary outcome of this analysis was metastasis-free survival (MFS) while secondary outcomes were time to prostate-specific antigen progression, overall survival, and adverse events. The Bucher technique for indirect comparison was used to compare apalutamide and enzalutamide using the common placebo comparator. We found no evidence of a significant difference in MFS (hazard ratio 1.04, 95% confidence interval 0.78–1.37) between enzalutamide and apalutamide. Similarly, there were no differences for any of the secondary outcomes. While indirect comparisons cannot supplant direct comparative data, this analysis suggests that apalutamide and enzalutamide are similarly effective in delaying metastases for patients with nmCRPC. Patient summary: Historically, there have been few treatment options for prostate cancer patients receiving androgen deprivation therapy who have rising prostate-specific antigen levels without obvious recurrence of cancer. Recent randomized controlled trials demonstrated that treatment with enzalutamide and apalutamide delayed the development of metastatic cancer. This study demonstrates through an indirect comparison that both medications are likely to have similar efficacy and side-effect profiles. Recent data support the use of apalutamide and enzalutamide in nonmetastatic castration-resistant prostate cancer. This analysis demonstrates no significant differences in efficacy and toxicity between these two agents.
KW - Androgen deprivation therapy
KW - Apalutamide
KW - Castration-resistant prostate cancer
KW - Enzalutamide
KW - Locally advanced prostate cancer
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U2 - 10.1016/j.euo.2018.04.004
DO - 10.1016/j.euo.2018.04.004
M3 - Article
C2 - 31102627
AN - SCOPUS:85057861920
VL - 1
SP - 238
EP - 241
JO - European Urology Oncology
JF - European Urology Oncology
SN - 2588-9311
IS - 3
ER -