The Role of Patient Preference and Efficacy in mHSPC Treatment Decisions

While a traditional head-to-head randomized controlled trial for enzalutamide vs darolutamide could be a lengthy undertaking, other study designs can provide valuable data more quickly. One such approach is a patient preference study, a methodology that has been successfully used in other areas of oncology. These studies are designed to understand what matters most to patients, such as minimizing specific side effects or maximizing convenience. When it comes to the choice between enzalutamide and darolutamide, some analyses based on patient preference have shown no significant differences in how patients perceive the overall toxicity of the two drugs. However, these same studies have sometimes suggested a potential edge for enzalutamide in terms of efficacy, specifically with higher response rates and better PSA outcomes.

This data, along with the results of the matching-adjusted indirect comparison (MAIC), strongly reinforces that enzalutamide is a highly effective treatment option. Researchers have long known that enzalutamide improves overall survival for patients with metastatic prostate cancer. Its use, along with other ARPIs, has significantly increased the chances of a patient being alive at five years. The cumulative evidence from various studies—including the ARCHES trial, patient preference analyses, and the recent MAIC—all points to enzalutamide’s robust efficacy.

Ultimately, all this information serves as a crucial resource for physicians faced with the complex decision of choosing the best treatment for an individual patient. The choice is rarely based on a single factor. A physician must weigh the strong evidence of enzalutamide’s efficacy against other considerations. For example, while enzalutamide may show a greater delay in disease progression, a different ARPI might have a more favorable safety profile for a patient with specific comorbidities. The patient’s preferences, lifestyle, and tolerance for potential side effects are also vital to this discussion.

Therefore, the availability of diverse data—from large-scale trials and statistical comparisons to real-world patient preferences—doesn’t provide a simple answer. Instead, it provides a comprehensive toolkit. This allows clinicians to have a nuanced conversation with their patients, balancing efficacy, safety, and personal values to make a truly informed and shared treatment decision.