# 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.

## Key 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.