Efficacy and safety of apalutamide, abiraterone acetate, and bicalutamide in the treatment of metastatic hormone-sensitive prostate cancer

TL;DR

This study compares three drugs for prostate cancer treatment and finds two newer drugs are more effective than an older one.

Contribution

The study provides a comparative analysis of apalutamide, abiraterone, and bicalutamide in metastatic hormone-sensitive prostate cancer.

Findings

Apalutamide and abiraterone significantly prolonged PFS and PSA-PFS compared to bicalutamide.

Apalutamide and abiraterone showed superior PSA response rates compared to bicalutamide.

No life-threatening adverse events were reported in any treatment group.

Abstract

To compare the efficacy and safety of three drugs—Apalutamide, Abiraterone, and Bicalutamide—combined with Androgen Deprivation Therapy (ADT) in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

We retrospectively collected survival data of patients treated at our hospital from January 2019 to March 2024. Patients who received three different treatment regimens—Apalutamide (240 mg/day) combined with ADT, Abiraterone (1000 mg/day) plus Prednisone (5 mg/day) combined with ADT, and Bicalutamide (50 mg/day) combined with ADT.

This study analyzed 146 mHSPC patients. The results are displayed that Apalutamide and Abiraterone significantly prolonged PFS and PSA-PFS compared to Bicalutamide. Univariate and multivariate COX regression analyses suggested that factors such as age <75 years, absence of lymph node metastasis, use of Apalutamide or Abiraterone, and a low ECOG score were associated with longer PFS. Moreover, Apalutamide and Abiraterone showed superior efficacy in improving PSA response compared to Bicalutamide. Importantly, no life-threatening adverse events were reported in any of the three treatment groups.

Compared to Bicalutamide, the novel endocrine therapies Apalutamide and Abiraterone both significantly prolong PFS, PSA-PFS, and improve PSA response rates.

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