Black patients with prostate cancer who were treated with the androgen receptor inhibitor darolutamide had clinical outcomes similar to those observed in the overall clinical trial population, according to results from the phase III ARAMIS trial presented by Neal Shore, MD, at the 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
“Compared with other racial and ethnic groups, Black individuals have disproportionately higher rates of prostate cancer incidence and mortality,” said Dr. Shore, Medical Director of the Carolina Urologic Research Center. “Despite this disparity, many clinical trials of prostate cancer therapies fail to publish demographic information on race and ethnicity.”
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The ARAMIS phase III clinical trial was designed to evaluate the efficacy and safety of darolutamide compared with placebo in combination with androgen-deprivation therapy in patients with high-risk nonmetastatic castration-resistant prostate cancer. In contrast to existing androgen receptor inhibitors, darolutamide exhibits low penetration of the blood-brain barrier and, therefore, may be associated with less risk of central nervous system adverse events, explained Dr. Shore. In addition, he noted that darolutamide has low potential to interact with other common medications.
Dr. Shore and colleagues previously reported in The New England Journal of Medicine that darolutamide significantly improved metastasis-free and overall survival and exhibited a favorable safety profile in patients enrolled in the ARAMIS trial. Their latest analyses evaluated the safety and efficacy of darolutamide specifically for the Black patients enrolled in the trial.
Darolutamide showed similar benefits for Black patients as observed in the overall ARAMIS population. Our study provides important findings that help to address the lack of data in Black patients who are disproportionally affected by prostate cancer.— Neal Shore, MD
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Subgroup Analysis
Among the 52 Black patients included in the analysis, 28 were treated with darolutamide and 24 received placebo. Patients treated with darolutamide compared with those who received placebo had longer metastasis-free survival (median = not reached in the darolutamide arm vs 12.4 months in the placebo arm) and a higher 3-year overall survival rate (100% vs 71%). Men treated with darolutamide also had longer time to first cytotoxic chemotherapy and longer time to disease progression.
Furthermore, the safety profile of darolutamide among Black patients was consistent with the results from the overall study population. The incidence of adverse events (82% vs 92%) and treatment discontinuation due to adverse events (4% vs 17%) was lower for darolutamide-treated patients compared with placebo-treated patients.
“Darolutamide showed similar benefits for Black patients as observed in the overall ARAMIS population,” said Dr. Shore. “Our study provides important findings that help to address the lack of data in Black patients who are disproportionally affected by prostate cancer. Additional research is warranted to better understand the disparity in outcomes in these patients and help guide treatment choices tailored to their individualized health-care needs.”
A limitation of the study was the small sample size of Black patients enrolled in the ARAMIS trial. “In future clinical trials, we need to improve participation of underrepresented populations through such efforts as building trust in the health-care system, utilizing patient advocates, and increasing awareness and educational opportunities,” Dr. Shore noted.
Disclosure: The study was supported by Bayer AG and Orion Pharma; Dr. Shore is an employee of GenesisCare and has served on the speaker’s bureau and as a consultant/advisor for Bayer, Janssen Scientific Affairs, Dendreon, Tolmar Inc., Ferring Pharmaceuticals, Medivation/Astellas, Amgen, Pfizer, AstraZeneca, Myovant Sciences, Astellas Pharma, AbbVie, Merck, Bristol Myers Squibb/Sanofi, Boston Scientific, Clovis Oncology, Exact Imaging, FerGene, Foundation Medicine, CG Oncology, InVitae, MDxHealth, Myriad Genetics, Nymox, Propella Therapeutics, Genzyme, Sanofi, and Sesen Bio. Shore has received research support from AbbVie, Amgen, Astellas Pharma, AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Boston Scientific, Clovis Oncology, Dendreon, Exact Imaging, Ferring, Foundation Medicine, InVitae, Janssen, MDxHealth, Merck, Myovant Sciences, Myriad Genetics, Nymox, Pfizer, Sanofi, Sesen Bio, and Tolmar Inc.
