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Research Article
9 May 2025

Overall survival in patients with metastatic castration-sensitive prostate cancer treated with apalutamide versus abiraterone acetate: a head-to-head analysis of real-world patients in the USA

Authors: Benjamin Lowentritt, Mehmet A Bilen, Ibrahim Khilfeh, Carmine Rossi, Shawn Du, Frederic Kinkead, Lilian Diaz, Dominic Pilon, Lorie Ellis, and Neal D Shore [email protected]Author Info & Affiliations
Volume 14, Number 7
https://doi.org/10.57264/cer-2025-0023
PDFFormats

Abstract

Aim: Head-to-head studies of survival outcomes associated with different androgen receptor pathway inhibitor (ARPI) treatments for metastatic castration (hormone)-sensitive prostate cancer have not been conducted. The purpose of this study was to compare 24-month overall survival among ARPI-naive patients with metastatic castration-sensitive prostate cancer (mCSPC) who initiated apalutamide or abiraterone acetate. Materials & methods: Linked de-identified clinical and claims healthcare databases were used to compare overall survival between patients with mCSPC initiating apalutamide or abiraterone acetate treated in community-based urology practices in the USA. Overall survival at 24 months post-treatment initiation (primary analyses) was compared between apalutamide and abiraterone acetate initiators using weighted Cox proportional hazards models (exploratory analyses used all available follow-up). Results: Overall, 1879 and 2073 patients had initiated apalutamide or abiraterone acetate, respectively (both cohorts: weighted mean age 72 years, 62% were white, and 66% had bone metastasis). At 24 months post-index, patients in the apalutamide cohort had a 26% lower risk of mortality compared with those in the abiraterone acetate cohort (hazard ratio: 0.74; 95% confidence interval: 0.59, 0.93; p = 0.010), with the difference maintained when outcomes were evaluated using all available follow-up (hazard ratio: 0.72; 95% confidence interval: 0.59, 0.88; nominal p < 0.001). Conclusion: In this nationally representative, real-world head-to-head analysis of nearly 4000 ARPI-naive patients with mCSPC, apalutamide was associated with a 26% reduction in the risk of mortality compared with abiraterone acetate by 24 months post-treatment initiation.

Graphical abstract

Graphical abstract comparing 24-month overall survival in ARPI-naïve mCSPC patients, showing a 26% mortality risk reduction with apalutamide versus abiraterone acetate; includes study design, baseline characteristics and survival curves.

Plain language summary

What was the aim of the study?

This retrospective longitudinal study compared 24-month overall survival between patients with metastatic castration-sensitive prostate cancer who were treated with apalutamide versus abiraterone acetate in the USA.

How was the research carried out?

A head-to-head, comparative effectiveness analysis was conducted between androgen receptor pathway inhibitor-naive patients treated with apalutamide versus abiraterone acetate using linked de-identified clinical and claims healthcare databases. Inverse probability of treatment weighting was used to balance patient baseline characteristics.

What were the results?

By 24 months after treatment initiation, there was a statistically significant 26% reduction in the risk of mortality among patients who initiated apalutamide (n = 1879) compared with abiraterone acetate (n = 2073; p = 0.010), which remained consistent in the exploratory analysis using all available follow-up data.

Why are findings important?

The results of this study show that compared with abiraterone acetate, initial treatment with apalutamide resulted in better real-world survival outcomes for patients with metastatic castration-sensitive prostate cancer and may provide a superior treatment option in clinical practice.

Supplementary Material

File (supplementary material.docx)

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