Elicit: Comparative Efficacy of AR Inhibitors
Comparative evidence: enzalutamide vs abiraterone or other AR pathway inhibitors
Enzalutamide and abiraterone provide similar overall survival in prostate cancer, but enzalutamide shows modest advantages for progression endpoints in castration-resistant disease, and sequencing from abiraterone to enzalutamide yields better outcomes than the reverse order due to preserved second-line activity.
Abstract
Ten studies including direct randomized trials, crossover studies, and network meta-analyses compared AR pathway inhibitors across metastatic castration-resistant, hormone-sensitive, and high-risk nonmetastatic prostate cancer settings...
Methods
We analyzed 10 sources from an initial pool of 200, using 9 screening criteria...
Paper search
We performed a semantic search across over 138 million academic papers from the Elicit search engine...
Screening
We screened in sources based on their abstracts that met these criteria:
- Population: Does the study include patients with prostate cancer receiving treatment with AR pathway inhibitors?
- Enzalutamide Intervention: Does the study include enzalutamide as one of the interventions being compared?
- AR Pathway Inhibitor Comparator: Does the study include abiraterone, apalutamide, darolutamide, or other AR pathway inhibitors as comparator(s)?
- Comparative Design: Does the study involve direct head-to-head comparison or indirect comparison through network meta-analysis?
...
Results
Characteristics of Included Studies
The systematic review included 10 studies comparing AR pathway inhibitors in prostate cancer across different disease settings and lines of therapy.
| Study | Full text retrieved? | Study Type | Sample Size | Disease Setting | Comparison | Follow-up |
|---|---|---|---|---|---|---|
| R. de Wit et al., 2019 | No | RCT | 255 (129 cabazitaxel, 126 ARPi) | Metastatic CRPC | Cabazitaxel vs abiraterone/enzalutamide | 9.2 months median |
| D. Khalaf et al., 2019 | Yes | RCT (crossover) | 202 (101 per arm) | Metastatic CRPC | Abiraterone→enzalutamide vs enzalutamide→abiraterone | 22.8 months median |
| ... |
Overall Survival
Overall survival data showed variable results across different disease contexts and treatment lines...
Progression-Free Survival
Progression-free survival outcomes varied substantially by disease setting and prior treatment...
PSA Response and Biochemical Outcomes
PSA response rates demonstrated notable variation across comparisons...
Tumor Response
Objective tumor response rates were reported in limited studies...
Safety and Tolerability
Overall adverse event rates showed considerable variation across studies...
Synthesis
The apparent contradictions in comparative efficacy between enzalutamide and abiraterone can be reconciled by examining context-specific factors.