Observational studyCancer medicine2026
Real-World Overall Survival With Abiraterone Acetate and Enzalutamide in Patients With Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer From the Flatiron Electronic Health Records Database.
Observational study in Cancer medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05968599 (A Real-World Comparison of Clinical Outcomes in Chemotherapy-naive Metastatic Castration-resistant Prostate Cancer), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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A Real-World Comparison of Clinical Outcomes in Chemotherapy-naive Metastatic Castration-resistant Prostate Cancer (mCRPC) Patients Who Initiated Enzalutamide vs. Abiraterone Acetate (Abiraterone) in Flatiron Electronic Health Record (EHR) Database
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9 authors.
Funding
Abstract
backgroundPatients with chemotherapy- and androgen receptor pathway inhibitor (ARPI)-naïve metastatic castration-resistant prostate cancer (mCRPC) have generally shown worse overall survival (OS) with abiraterone versus enzalutamide in claims database studies. Given limitations of claims data, analysis using detailed electronic health records (EHRs) is needed to confirm this finding.
methodsThis EHR-based analysis (2014-2023) of the Flatiron Health database included patients with chemotherapy- and ARPI-naïve mCRPC who initiated first-line ARPI (abiraterone or enzalutamide). OS, treatment duration, and time to subsequent therapy were assessed. A subgroup analysis evaluated patients who received first-line ARPI only with no subsequent treatments. Kaplan-Meier method and Cox proportional hazards models evaluated time-to-event outcomes. Stabilized inverse probability treatment weighting (sIPTW) adjusted for baseline differences.
resultsAmong 2731 patients, 1316 received first-line abiraterone and 1415 enzalutamide (median follow-up: 21.8 and 23.2 months, respectively). sIPTW-adjusted median OS (24.6 vs. 25.8 months; hazard ratio [HR] 1.13; 95% confidence interval [CI], 1.03-1.23), treatment duration (7.9 vs. 9.5 months; HR 1.21; 95% CI, 1.11-1.31), and time to subsequent therapy (14.7 vs. 17.9 months; HR 1.20; 95% CI, 1.08-1.32) were shorter with abiraterone versus enzalutamide. Among the 40% with no subsequent treatment (n = 1102), sIPTW-adjusted median OS (14.0 vs. 17.7 months; HR 1.32; 95% CI, 1.14-1.53), and treatment duration (7.5 vs. 10.6 months; HR 1.30; 95% CI, 1.12-1.50) were also shorter with abiraterone versus enzalutamide.
conclusionsUsing more detailed data abstraction, these results confirm prior claims-based analyses showing that despite early use of subsequent therapy, first-line abiraterone is associated with shorter OS versus enzalutamide in ARPI- and chemotherapy-naïve mCRPC.
trial registrationClinical Trial ID: NCT05968599.
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