Dr. Freedland on a Real-World Analysis of Enzalutamide in mCRPC

Stephen J. Freedland, MD, Warschaw Robertson Law Families Chair in Prostate Cancer, director, Center for Integrated Research in Cancer and Lifestyle, co-director, Cancer Genetics and Prevention Program, associate director, Faculty Development Samuel Oschin Comprehensive Cancer Institute, and professor of surgery, Cedars-Sinai Medical Center, discusses a real-world analysis of enzalutamide (Xtandi) in metastatic castration-resistant prostate cancer (mCRPC).

Data from the randomized phase III PREVAIL trial showed a decrease in radiographic progression-free survival and overall survival with enzalutamide versus placebo in men with chemotherapy-naïve, metastatic prostate cancer.

Prior to the 2018 approval of enzalutamide in nonmetastatic CRPC, a retrospective cohort study analyzed the real-world utility of enzalutamide in 931 men with chemotherapy-naïve, mCRPC. Due to the agent’s approval in the nonmetastatic setting in the study time frame, the use of enzalutamide was used as a proxy for mCRPC, says Freedland.

At a median follow-up of 12.5 months and a median of 4 completed prostate-specific antigen (PSA) tests, the median PSA decline was 58%, says Freedland. Moreover, 14.2% of patients had undetectable PSA. Additionally, the median time to PSA progression was 18.5 months (95% CI, 15.6-23.7).

A subset of patients did not respond to treatment with enzalutamide; however, this may be due to inherent resistance to hormonal therapy, explains Freedland.

These findings are comparable to those from the PREVAIL trial, indicating the real-world utility of enzalutamide in this patient population, concludes Freedland.