e17092 Background: Abiraterone and darolutamide are among several novel androgen receptor pathway inhibitors (ARPIs) that have demonstrated improved survival outcomes when added to androgen deprivation therapy (ADT) in patients with hormone-sensitive prostate cancer (HSPC). Despite their established efficacy, there are currently no high-level evidence data directly comparing abiraterone and darolutamide when combined with ADT prior to the initiation of chemotherapy. Methods: We conducted a retrospective cohort study using the TriNetX database to identify adult patients (≥18 years) with HSPC defined using ICD-10 diagnosis codes. After propensity score matching to balance baseline characteristics, each of the abiraterone and darolutamide cohorts included 363 patients. Prior exposure to docetaxel was excluded from both cohorts. The primary outcomes were the percentage of patients who developed hormone-resistant disease and overall survival. Comparative outcome analyses were performed, and overall survival was evaluated using Kaplan–Meier analysis. Results: The mean age at diagnosis was 73 years. The majority of patients were White 73%, while 19% were Black or African American. The percentage of patients developing hormone-resistant disease was significantly higher in the abiraterone group compared with the darolutamide group (23.8% vs 9.1%, p < 0.0001; OR 3.1; 95% CI, 1.9–5.0). Kaplan–Meier survival analysis demonstrated significantly worse overall survival in patients treated with abiraterone compared with those treated with darolutamide. All-cause mortality was also higher in the abiraterone group (OR 3.4; 95% CI, 2.3–5.1). During follow-up, median overall survival was 60 months in the abiraterone group, while median survival was not reached in the darolutamide group. The difference was statistically significant and treatment with abiraterone was associated with a higher risk of death (log-rank p = 0.006; HR 1.65; 95% CI, 1.14–2.37). Conclusions: In this real-world analysis of patients with HSPC treated with ADT plus an ARPI prior to chemotherapy, darolutamide was associated with lower rates of developing hormone-resistant disease and improved overall survival compared to abiraterone. These findings suggest meaningful differences in outcomes between ARPIs in the pre-chemotherapy setting, however, confirmation in prospective comparative studies is warranted.
Antonios et al. (Thu,) studied this question.