Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer

Author(s): Matthew R. Smith, M.D., Ph.D., Maha Hussain, M.D., Fred Saad, M.D., Karim Fizazi, M.D., Ph.D., Cora N. Sternberg, M.D., E. David Crawford, M.D., Evgeny Kopyltsov, M.D., Chandler H. Park, M.D., Boris Alekseev, M.D., Álvaro Montesa-Pino, M.D., Dingwei Ye, M.D., Francis Parnis, M.B., B.S., et al., for the ARASENS Trial Investigators*
Source: N Engl J Med 2022; 386:1132-1142 DOI: 10.1056/NEJMoa2119115
Lucio Gordan MD

Dr. Gordan's Thoughts

Practice-changing study for this specific patient population (see inclusion criteria) with approximately 30% risk reduction of death with excellent tolerability of treatment arm of this study.

BACKGROUND

Darolutamide is a potent androgen-receptor inhibitor that has been associated with increased overall survival among patients with nonmetastatic, castration-resistant prostate cancer. Whether a combination of darolutamide, androgen-deprivation therapy, and docetaxel would increase survival among patients with metastatic, hormone-sensitive prostate cancer is unknown.

METHODS

In this international, phase 3 trial, we randomly assigned patients with metastatic, hormone-sensitive prostate cancer in a 1:1 ratio to receive darolutamide (at a dose of 600 mg [two 300-mg tablets] twice daily) or matching placebo, both in combination with androgen-deprivation therapy and docetaxel. The primary end point was overall survival.

RESULTS

Darolutamide and Survival
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The primary analysis involved 1306 patients (651 in the darolutamide group and 655 in the placebo group); 86.1% of the patients had disease that was metastatic at the time of the initial diagnosis. At the data cutoff date for the primary analysis (October 25, 2021), the risk of death was significantly lower, by 32.5%, in the darolutamide group than in the placebo group (hazard ratio 0.68; 95% confidence interval, 0.57 to 0.80; P<0.001). Darolutamide was also associated with consistent benefits with respect to the secondary end points and prespecified subgroups. Adverse events were similar in the two groups, and the incidences of the most common adverse events (occurring in ≥10% of the patients) were highest during the overlapping docetaxel treatment period in both groups. The frequency of grade 3 or 4 adverse events was 66.1% in the darolutamide group and 63.5% in the placebo group; neutropenia was the most common grade 3 or 4 adverse event (in 33.7% and 34.2%, respectively).

CONCLUSIONS

In this trial involving patients with metastatic, hormone-sensitive prostate cancer, overall survival was significantly longer with the combination of darolutamide, androgen-deprivation therapy, and docetaxel than with placebo plus androgen-deprivation therapy and docetaxel, and the addition of darolutamide led to improvement in key secondary end points. The frequency of adverse events was similar in the two groups. (Funded by Bayer and Orion Pharma; ARASENS ClinicalTrials.gov number, NCT02799602. opens in new tab.)

Author Affiliations

From the Massachusetts General Hospital Cancer Center and Harvard Medical School — both in Boston (M.R.S.); the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago (M.H.); the University of Montreal Hospital Center, Montreal (F.S.); Institut Gustave Roussy, University of Paris–Saclay, Villejuif, France (K.F.); the Englander Institute for Precision Medicine, Weill Cornell Medicine, Meyer Cancer Center, New York–Presbyterian Hospital, New York (C.N.S.); the University of California San Diego School of Medicine, La Jolla (E.D.C.); the Clinical Oncologic Dispensary of Omsk Region, Omsk (E.K.), and P. Hertsen Moscow Oncology Research Institute, Moscow (B.A.) — both in Russia; Norton Cancer Institute, Louisville, KY (C.H.P.); La Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (A.M.-P.), and Maimonides Institute for Biomedical Research of Córdoba, Reina Sofía University Hospital, Cordoba (M.J.M.-V.) — both in Spain; Fudan University Shanghai Cancer Center, Shanghai (D.Y.), and Liaoning Cancer Hospital and Institute, Shenyang (C.F.) — both in China; Ashford Cancer Centre Research, Kurralta Park, SA, Australia (F.P.); Núcleo de Pesquisa e Ensino da Rede São Camilo, São Paulo (F.C.); Tampere University Hospital and Tampere University, Tampere (T.L.J.T.), Helsinki University Central Hospital, Comprehensive Cancer Center, Helsinki (T.U.), and Orion Pharma, Espoo (H.J.) — all in Finland; Toho University Sakura Medical Center, Chiba (H.S.), and Osaka University Hospital, Osaka (M.U.) — both in Japan; the Huntsman Cancer Institute, Salt Lake City (B.L.M.); Bayer, Berlin (S.T., I.K.); Bayer HealthCare, Whippany, NJ (R.L.); and the Division of Urology, Institut de Recherche Clinique, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels (B.T.).

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