Opinion
Video
Deciding on a Treatment Approach for mHSPC
Author(s):
A panelist discusses how clinicians should weigh the decision between enzalutamide and darolutamide for patients with metastatic hormone-sensitive prostate cancer (mHSPC) by considering each drug’s efficacy profile alongside their distinct adverse effect patterns, particularly darolutamide’s favorable central nervous system (CNS) toxicity profile vs enzalutamide’s more established long-term data, while also factoring in individual patient characteristics such as age, comorbidities, and potential drug interactions.
Summary for Physicians: Selecting Between Enzalutamide and Darolutamide for mHSPC
The question of how to choose between enzalutamide and darolutamide for patients with mHSPC should consider:
- Efficacy: Both agents have demonstrated significant benefits in mHSPC, with comparable radiographic progression-free survival improvements.
- Patient characteristics: Consider individual comorbidities, drug interactions, and risk factors.
- Tolerability profiles: Darolutamide may offer advantages in patients with concerns about CNS adverse effects, fatigue, or fall risk due to its minimal blood-brain barrier penetration.
- Polypharmacy considerations: Evaluate existing medications and potential drug interactions, which may differ between agents.
- Patient preferences: Discuss quality-of-life considerations and treatment goals with each patient.
The decision should be individualized based on these factors rather than assuming superiority of one agent over the other for all patients with mHSPC.
