Gimme the loot.

Top Line: We’re bring you the next next-generation androgen receptor inhibitor with even fewer side effects.
The Study: It’s surprising we didn’t see many ‘lutamide commercials this Super Bowl considering the fierce competition for turf among treatments for nonmetastatic castration resistant prostate cancer (CRPC). Back in the summer we told you about the surprisingly similar results of the PROSPER and SPARTAN trials where both enzalutamide and apalutamide combined with androgen deprivation therapy (ADT) substantially prolonged metastasis-free survival from the 15-20 to the 35-40 month range. Because all good things happen in 3’s (especially Super Bowl scoring), the ARAMIS trial now reports shockingly similar results to the SPARTAN and PROSPER trials. In ARAMIS, which again required patients to have PSA doubling time < 10 months, adding darolutamide to ADT prolonged metastasis free survival from 18 → 40 months. So why another ‘lutamide? Well, darolutamide is touted as having a different chemical structure that may reduce toxicity—and it did just that. In contrast to enzalutamide and apalutamide, the rate of adverse events with darolutamide was no different from ADT alone.
Bottom Line: Darolutamide, like apalutamide and enzalutamide, dramatically prolongs metastasis-free survival in men with nonmetastatic CRPC and a PSA doubling time < 10 months, but with no increase in side effects. | Fizazi, N Engl J Med 2019


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