Key clinical point: Apalutamide and enzalutamide appear to be more effective than darolutamide for treatment of nonmetastatic castration-resistant prostate cancer, whereas darolutamide appears to have the most favorable tolerability profile.

Major finding: Apalutamide (hazard ratio [HR], 0.85; 95% credible interval [CrI], 0.77-0.94) and enzalutamide (HR, 0.86; 95% CrI, 0.78-0.95) resulted in a significantly improved metastasis-free survival. Apalutamide had the highest likelihood of providing the maximal prostate-specific antigen progression-free survival (P score, 1.0000), followed by enzalutamide (P score, 0.6667). Darolutamide had the lowest likelihood for any grade, grade 3-4, or grade 5 adverse events vs. apalutamide and enzalutamide.

Study details: A network meta-analysis of 3 studies including 4,117 patients who received either placebo (n = 1,423) or next-generation androgen receptor inhibitors (n = 2,694).

Disclosures: Open access funding was provided by Medical University of Vienna. The authors declared no conflicts of interest.