New clinical trial data presented at ASCO 2026 suggests darolutamide is less likely to cause cognitive decline than enzalutamide in men with prostate cancer.
The phase 2 ARACOG trial, also known as AFT 47, compared cognitive and quality-of-life outcomes in 111 patients with various stages of prostate cancer. Participants were randomized 1:1 to receive either darolutamide or enzalutamide.
Cognitive performance was measured using the CANTAB computerized assessment platform at baseline and at 12, 24, and 48 weeks. The primary endpoint was the percent change from baseline to 24 weeks in the most impacted cognitive domain.
Results showed a median cognitive decline of minus 15.8% for darolutamide, compared to minus 36.1% for enzalutamide-a statistically significant difference favoring darolutamide. Notably, all 23 patients who crossed over to darolutamide by 24 weeks had originally been on enzalutamide.
Further long-term follow-up is ongoing.