The combination of apalutamide and abiraterone acetate plus prednisone, which previously demonstrated little overall survival benefit in White patients with metastatic prostate cancer, may yield better survival outcomes in Black patients with the disease, according to new findings presented by George et al at the 2023 ASCO Annual Meeting (Abstract 5015).
Background
Black patients are more likely to develop prostate cancer and twice as likely to die from the disease than White patients. When treated, however, Black patients have demonstrated response rates that are similar to or better than those of White patients.
Abiraterone acetate plus prednisone and apalutamide inhibit testosterone signaling in prostate cancer through different mechanisms and have shown independent overall survival benefits for patients with metastatic prostate cancer.
Study Methods and Results
In the new PANTHER study, researchers administered the combination therapy to 43 Black patients and 50 White patients with metastatic prostate cancer. Both groups received care at the same institutions by the same care teams and received the same treatment for 2 years or until the cancer progressed. After follow-up, the researchers discovered that only 14% of the Black patients died compared with 33% of the White patients.
In addition to the overall survival benefit, the interim results showed that Black patients had a median progression-free survival of 30 months compared with 15 months for the White patients. Further, Black patients exhibited greater declines in prostate-specific antibody levels compared with the White patients.
“This research shows the importance of diversity in clinical trials,” emphasized lead study author Daniel George, MD, Professor of Medicine and Surgery at the Duke University School of Medicine. “Without a larger percentage of Black participants, you would not pick up this important signal that Black [patients] benefit differently than [White patients]. I wonder how many similar signals we are missing because we don’t have adequate diversity in studies. You can’t assume that a lack of benefit in White patients applies to Black [patients],” he suggested.
Conclusions
“We saw signals of [the overall survival benefits] in an earlier study using one hormonal therapy, but not to this degree,” Dr. George explained. “This really speaks to the need to design studies that include more Black participants, because there can be significant differences in the outcomes,” he concluded.
Disclosure: The research in this study was funded by Janssen Pharmaceuticals. For full disclosures of the study authors, visit meetings.asco.org.
