Enzalutamide (Xtandi) and abiraterone (Zytiga) may have similar effectiveness in metastatic castration-sensitive prostate cancer

1. The use of enzalutamide (Xtandi) and abiraterone (Zytiga) in metastatic castration-sensitive prostate cancer (mCSPC) was associated with similar overall survival (OS).

2. The use of enzalutamide was associated with an improved OS among patients over the age of 75 years. 

Evidence Rating Level: 2 (Good)

Enzalutamide and abiraterone are two androgen-receptor pathway inhibitors (ARPI) approved for the treatment of mCPSC. However, while they both target the same pathway, their mechanisms of action differ and no clinical trials have compared these two compounds head-to-head. This retrospective cohort study therefore sought to compare clinical outcomes among patients with mCPSC treated with enzalutamide or abiraterone. 5,135 patients (median[IQR] age, 74.33[69.66-78.88] years) from the Veterans Affairs health care system in the United States were included in the study. When analyzing the OS, the restricted mean survival time (RMST) at 3 years was comparable between the enzalutamide group (27.99 months [95% CI, 27.37 to 28.61]) and the abiraterone group (27.27 months [95% CI, 26.79 to 27.74]). However, among patients 75 years of age or older, the RMST at 3 years for the enzalutamide group was 26.47 months (95% CI, 25.49 to 27.44) compared to 24.82 months for the abiraterone group (95% CI, 24.04 to 25.59). Overall, this study found that among patients with mCPSC, enzalutamide and abiraterone had similar OS outcomes. However, enzalutamide may have a specific benefit among older patients. 

Click here to read the study in the Journal of Clinical Oncology

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