Dr Lowentritt on the Implications of Data on Real-World ASRI Efficacy in mCSPC

Benjamin H. Lowentritt, MD, FACS, director, Minimally Invasive Surgery and Robotics, Chesapeake Urology, discusses how results from a real-world retrospective study of responses with second-generation androgen receptor signaling inhibitors (ARSIs) in patients with metastatic castration-sensitive prostate cancer (mCSPC) could affect the selection and use of next-generation ARSIs in practice, and how this research identifies several other unanswered questions for future investigation.

The ARSIs abiraterone acetate (Zytiga), apalutamide (Erleada) and enzalutamide (Xtandi) all received FDA approval in mCSPC between 2018 and 2020, Lowentritt begins. Although these agents have shown efficacy in the clinical trial setting, their activity in clinic had not been assessed. As such, a retrospective, longitudinal descriptive analysis of prostate-specific antigen (PSA) response and time to castration resistance was conducted in patients with mCSPC who received apalutamide, enzalutamide, or abiraterone acetate, Lowentritt continues.

Data presented at the 2023 American Urological Association Annual Meeting revealed that apalutamide administration correlated with superior PSA responses rates and time to castration resistance compared with enzalutamide or abiraterone acetate for patients treated in community settings.

These findings indicate the importance of understanding and considering the use of all approved ARSIs within this population, as individual tolerability and responses will likely differ, Lowentritt says.

Although the study included a similar number of patients in each cohort, it was not comprised of heavily matched cohorts, and patients were unable to be stratified according to certain features. Therefore, future real-world studies should attempt to include more directly comparable groups, Lowentritt explains. Additionally, strategies to extract and interpret meaningful data from electronic medical records (EMRs) in this space continue to improve, Lowentritt adds. However, expanding the assessment of EMRs across different groups, states, and patient populations could unearth unique efficacy or safety signals that require further investigation, Lowentritt concludes.