Darolutamide shows less cognitive decline than enzalutamide in advanced prostate cancer
Published on 30 May 2026
Dr Morgans talks to ecancer at ASCO 2026 about results she presented from the phase 2 ARACOG (AFT-47) randomized trial.
Darolutamide was associated with significantly less cognitive decline than enzalutamide in patients with advanced prostate cancer, including metastatic hormone-sensitive and castration-resistant disease.
Dr Morgans notes that among 111 enrolled patients, cognitive function assessed by the CANTAB platform showed a smaller median decline in the most affected cognitive domain at 24 weeks with darolutamide (-15.8%) compared with enzalutamide (-36.1%; p=0.009).
Darolutamide-treated patients demonstrated stable or improved performance across several domains, suggesting a potential learning effect, whereas enzalutamide was associated with stable to worsening scores.
All treatment crossovers occurred from enzalutamide to darolutamide, primarily due to cognitive deterioration, supporting a more favorable central nervous system tolerability profile for darolutamide.