Matching-adjusted indirect comparison of enzalutamide versus apalutamide with androgen-deprivation therapy in patients with metastatic hormone-sensitive prostate cancer

Aims To compare the efficacy of enzalutamide + androgen-deprivation therapy (ADT) versus apalutamide + ADT in metastatic hormone-sensitive prostate cancer (mHSPC) using a matching-adjusted indirect comparison (MAIC).Patients and methods Individual patient data from patients with ≥1 confirmed bone metastasis in ARCHES (NCT02677896; enzalutamide + ADT vs placebo + ADT; n = 971) were adjusted to match baseline characteristics of patients in TITAN (NCT02489318; apalutamide + ADT vs placebo + ADT; N = 1052). Overall survival (OS), radiographic progression-free survival (rPFS), and time to prostate-specific antigen progression (TTPP) were assessed using Cox regression with placebo + ADT as the common comparator. Hazard ratios (HRs) were reported with apalutamide as the reference.Results This MAIC suggested similar estimated efficacy between enzalutamide and apalutamide for OS (HR: 0.81, 95% confidence interval [CI]: 0.58–1.15) and TTPP (HR: 0.65, 95% CI: 0.41–1.03). Patients treated with enzalutamide + ADT had improved rPFS versus those treated with apalutamide + ADT (HR: 0.66, 95% CI: 0.45–0.98), but differences were not significant in sensitivity analyses aligning assessment methods.Conclusions This analysis suggested broadly similar efficacy between enzalutamide and apalutamide in patients with mHSPC. Findings should be interpreted in the context of inherent MAIC limitations.