A recent real-world study analyzed the effectiveness of apalutamide (APA) as a first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC) in the United States, using data from nearly 5,000 patients (from 2013 to 2018)

The findings show that APA combined with androgen-deprivation therapy (ADT) leads to significantly better outcomes than other commonly used therapies, including enzalutamide (ENZ), abiraterone acetate (AAP), and ADT alone. Patients treated with APA+ADT had higher rates of PSA response, longer overall survival (OS), and longer time to castration resistance (TTCR). At 24 months, survival rates for APA+ADT were 66%, compared to 55% for ENZ+ADT and 59% for AAP+ADT, and the risk of death was significantly lower for those treated with APA.

However, the study lacks a direct comparison with darolutamide (DARO), which is increasingly considered a standard of care in the realm of androgen receptor signaling inhibitors (ARSIs). The omission of DARO in this analysis limits the study’s applicability in the evolving treatment landscape, as its efficacy in similar settings makes it an important benchmark for comparison.

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