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Abiraterone Acetate, Apalutamide, Docetaxel Improve Outcomes in Metastatic CSPC

Certain treatment options when added to androgen-deprivation therapy (ADT) have improved overall survival (OS) among those with metastatic castration-sensitive prostate cancer (mCSPC), according to a study by Lin Wang, MD, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and colleagues (JAMA Oncol. 2021 Jan 14. Epub ahead of print).

The study, an analysis of 7 randomized clinical trials including 2287 patients with mCSPC, evaluated the addition of 6 treatments—docetaxel, abiraterone acetate, apalutamide, enzalutamide, standard nonsteroidal antiandrogen, and a placebo/no treatment—to ADT to figure out the most effective and safe treatment options.

Ordered from greatest to least effective, abiraterone acetate (hazard ratio [HR], 0.61; 95% CI, 0.54-0.70), apalutamide (HR, 0.67; 95% CI, 0.51-0.89), and docetaxel (HR, 0.79; 95% CI, 0.71-0.89) treatments significantly improved OS outcomes, while enzalutamide (HR, 0.39; 95% CI, 0.30-0.50), apalutamide (HR, 0.48; 95% CI, 0.39-0.60), abiraterone acetate (HR, 0.51; 95% CI, 0.45-0.58), and docetaxel (HR, 0.67; 95% CI 0.60-0.74) significantly improved radiographic progression-free survival.

Docetaxel substantially increased serious adverse events (odds ratio, 23.72; 95% CI, 13.37-45.15) and abiraterone acetate slightly increased serious adverse events (odds ratio, 1.42; 95% CI, 1.10-1.83).

These findings suggest that among mCSPC treatments, abiraterone acetate and apalutamide may provide the most consistent OS benefits with relatively low serious adverse event risks.Emily Bader

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