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Enzalutamide with standard first-line therapy in metastatic prostate cancer

Abstract

BACKGROUND: Enzalutamide, an androgen-receptor inhibitor, has been associated with improved overall survival in men with castration-resistant prostate cancer. It is not known whether adding enzalutamide to testosterone suppression, with or without early docetaxel, will improve survival in men with metastatic, hormone-sensitive prostate cancer. METHODS: In this open-label, randomized, phase 3 trial, we assigned patients to receive testosterone suppression plus either open-label enzalutamide or a standard nonsteroidal antiandrogen therapy (standard-care group). The primary end point was overall survival. Secondary end points included progression-free survival as determined by the prostate-specific antigen (PSA) level, clinical progression-free survival, and adverse events. RESULTS: A total of 1125 men underwent randomization; the median follow-up was 34 months. There were 102 deaths in the enzalutamide group and 143 deaths in the standard-care group (hazard ratio, 0.67; 95% confidence interval [CI], 0.52 to 0.86; P = 0.002). Kaplan-Meier estimates of overall survival at 3 years were 80% (based on 94 events) in the enzalutamide group and 72% (based on 130 events) in the standard-care group. Better results with enzalutamide were also seen in PSA progression-free survival (174 and 333 events, respectively; hazard ratio, 0.39; P<0.001) and in clinical progression-free survival (167 and 320 events, respectively; hazard ratio, 0.40; P<0.001). Treatment discontinuation due to adverse events was more frequent in the enzalutamide group than in the standard-care group (33 events and 14 events, respectively). Fatigue was more common in the enzalutamide group; seizures occurred in 7 patients in the enzalutamide group (1%) and in no patients in the standard-care group. CONCLUSIONS: Enzalutamide was associated with significantly longer progression-free and overall survival than standard care in men with metastatic, hormone-sensitive prostate cancer receiving testosterone suppression. The enzalutamide group had a higher incidence of seizures and other toxic effects, especially among those treated with early docetaxel. (Funded by Astellas Scientific and Medical Affairs and others; ENZAMET (ANZUP 1304) ANZCTR number, ACTRN12614000110684; ClinicalTrials.gov number, NCT02446405; and EU Clinical Trials Register number, 2014-003190-42.).

Type Journal
ISBN 0028-4793
Authors Davis, I. D.; Martin, A. J.; Stockler, M. R.; Begbie, S.; Chi, K. N.; Chowdhury, S.; Coskinas, X.; Frydenberg, M.; Hague, W. E.; Horvath, L. G.; Joshua, A. M.; Lawrence, N. J.; Marx, G.; McCaffrey, J.; McDermott, R.; McJannett, M.; North, S. A.; Parnis, F.; Parulekar, W.; Pook, D. W.; Reaume, M. N.; Sandhu, S. K.; Tan, A.; Tan, T. H.; Thomson, A.; Tu, E.; Vera-Badillo, F.; Williams, S. G.; Yip, S.; Zhang, A. Y.; Zielinski, R. R.; Sweeney, C. J.
Responsible Garvan Author Dr Anthony Joshua
Publisher Name NEW ENGLAND JOURNAL OF MEDICINE
Published Date 2019-07-11
Published Volume 381
Published Issue 2
Published Pages 121-131
Status Published in-print
DOI 10.1056/NEJMoa1903835