Androgen Receptor Signaling Inhibitors in Non-Metastatic Castration-Resistant Prostate Cancer in Japan: The ARASHI...

Area of Science:

• Oncology
• Pharmacology
• Clinical Research

Background:

• Non-metastatic castration-resistant prostate cancer (nmCRPC) requires effective treatment to delay progression.
• Androgen receptor signaling inhibitors (ARSIs) like darolutamide, enzalutamide, and apalutamide are key therapies.
• Understanding real-world clinical use and outcomes in specific populations is crucial.

Purpose of the Study:

• To evaluate the clinical use and patient outcomes of three ARSIs in Japan.
• To compare treatment discontinuation rates and time to progression to metastatic CRPC (mCRPC).
• To provide insights into ARSI effectiveness in a Japanese nmCRPC cohort.

Main Methods:

• Retrospective observational study using Japanese acute care hospital claims data (2020-2023).
• Included patients with nmCRPC initiating darolutamide, enzalutamide, or apalutamide.
• Key outcomes: time to ARSI discontinuation and time to progression to mCRPC.

Main Results:

• Darolutamide was associated with significantly longer median time to discontinuation (16.1 months) versus enzalutamide (12.3 months) and apalutamide (7.1 months).
• Progression to mCRPC by 24 months was lower for darolutamide (27%) compared to enzalutamide (37%) and apalutamide (40%).
• Higher proportion of patients initiated darolutamide at the labeled dose (78%) compared to enzalutamide (58%) and apalutamide (62%).

Conclusions:

• Darolutamide demonstrated superior treatment persistence and delayed progression to mCRPC in Japanese nmCRPC patients.
• These findings suggest potential benefits of darolutamide in real-world clinical settings.
• Further research may explore mechanisms behind these observed differences in outcomes.