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Tanya Dorff and Alicia Morgans discuss the design of the ENZAMET trial (Enzalutamide in first-line androgen replacement therapy for metastatic prostate cancer) and key takeaway messages based on the plenary presentation of the trial. ASCO 2019 by Christopher Sweeney. The researchers hypothesized that adding enzalutamide to first-line treatment would delay the onset of castration resistance and improve overall survival. In the ENZAMET trial, the goal was to determine the effects of adding enzalutamide to a first-line treatment including the suppression of testosterone with or without starting docetaxel. The ENZAMET study was a study of patients with metastatic and hormone-sensitive prostate cancer; therefore, she was recently diagnosed as an ADD, and the clinical question was whether immediate administration of enzalutamide over standard androgen receptor therapy, such as bicalutamide, flutamide or nilutamide, would improve survival. The primary endpoint was overall survival. Secondary endpoints included progression-free survival determined by prostate specific antigen (PSA) level, clinical progression-free survival, and adverse events. Enzalutamide was badociated with significantly longer progression-free and overall survival than conventional care in men with metastatic and hormone-sensitive prostate cancer, which was undergoing testosterone suppression. The enzalutamide group had a higher incidence of seizures and other toxic effects, particularly in those treated with early docetaxel. Dr. Dorff emphasized the importance of non-corticosteroid treatment other than docetaxel and even abiraterone. She also concludes that it is essential to fight early and permanently against prostate cancer to fight cancer in the long term. There is no convincing evidence of the efficacy of taking docetaxel and enzalutamide from these findings and that multiple options for immediate intensification beyond LHRH or castration therapy should be used.
Biographies:
Tanya B. Dorff, MD, Clinical Associate Professor in the Department of Research in Medical Oncology and Therapeutics, Head of the Genito-Urinary Cancer Program at City of Hope
Alicia Morgans, MD, MPH Associate Professor of Medicine at the Division of Hematology / Oncology at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois.
Related content:
Overall survival results of a randomized phase III trial on standard treatment with or without enzalutamide in the treatment of hormone-sensitive metastatic prostate cancer: ENZAMET, a study conducted by the International Cooperative Group (ANZUP)
ENZAMET NCT02446405: Randomized Phase 3 Trial of Enzalutamide in the First-Order Androgen deprivation Treatment of Metastatic Prostate Cancer
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