Cancer
Comparison of enzalutamide, abiraterone, and apalutamide for prostate cancer outcomes: a target trial emulation using data from the IRONMAN Registry Connor Grady* Connor Grady Jordan Tuai Xabier García-Albéniz Emma McGee Philip Kantoff Lorelei Mucci Barbra Dickerman
The clinical landscape for men with advanced prostate cancer is rapidly evolving, with the introduction of several new therapies over the past decade – including androgen receptor signaling inhibitors (ARSIs) – that have been shown to improve survival. However, further evidence to inform the optimal selection and sequencing of these agents is needed.
In this study, we will use observational data from the IRONMAN registry, an international, prospective cohort of >4,300 men with advanced prostate cancer, to emulate a target trial of ARSIs (enzalutamide, abiraterone, apalutamide) and risk of progression and death among individuals with metastatic prostate cancer. We will use inverse-probability weighted pooled logistic regression models to estimate intention-to-treat and per-protocol effects of dynamic treatment strategies, adjusting for baseline and time-varying confounders. To identify potential subgroups of individuals for whom the treatment strategies may be most beneficial, we will conduct analyses separately in subsets of the population defined at baseline according to demographic and clinical features. These findings will help to inform clinical recommendations for individuals with metastatic prostate cancer, as well as the design of future studies aimed at evaluating different selections and sequencing of cancer treatments.