Dr. Bryce on Treatment Selection in Nonmetastatic Castration-Resistant Prostate Cancer

Alan H. Bryce, MD, assistant professor of medicine, Mayo Clinic, discusses treatment selection in nonmetastatic castration-resistant prostate cancer (M0CRPC).

Enzalutamide (Xtandi), apalutamide (Erleada), and darolutamide (Nubeqa) are approved for the treatment of patients with M0CRPC based on data from the phase III PROSPER, SPARTAN, and ARAMIS trials, respectively. The trials were designed similarly and they launched within a few years of each other, says Bryce. Although cross-trial comparisons are discouraged, the results from all 3 trials showed a similar benefit in metastasis-free survival ranging from 3 to 4 years with the antiandrogen versus the comparator.

However, the drugs do differ in their toxicity profiles and administration schedules, says Bryce. For example, darolutamide is given twice daily rather than once daily. Because there are no head-to-head data comparing these agents, it will be important for the field to gain experience in the clinic to learn which patients are going to do better with which agent, Bryce concludes.