Enzalutamide is a new antiandrogen recently approved for treatment of M0 castration-resistant prostate cancer. The most recent guidelines state that M0 stage is expectant, there is no recommendation for early treatment. However, the early use of this therapy has been shown to reduce development of metastasis in castration-resistant patients.
The results of use of enzalutamide in M0 patients in the PROSPER study are presented. Although more adverse effects (hypertension, seizures and cardiovascular events) in the group of androgen blockade plus enzalutamide vs androgen blockade plus placebo, the enzalutamide group show significantly better progression-free survival (14 months vs 36 months). Not only did it reduce the progression, it also reduced significantly the PSA progression and delayed the use of chemotherapy. However, it did not alter the global survival.
Román Carvajal García, MD, concludes that the therapy is well tolerated and there is a clear advantage in progression-free survival and also in secondary objectives (PSA progression, delay chemotherapy use). The plenary did not include comparisons between other therapies for M0 CRPC, it was focused just on enzalutamide. Other therapies were analyzed later in the meeting.
Presented by: Carvajal García, Román, MD at Hospital Zapopan, Zapopan, Jalisco, Mexico.
Written by: Carlos Jimenez Ornelas, MD. Resident of Urology. Instituto Nacional Ciencias Medicas y Nutricion Salvador Zubiran @dr.jimorn along with Ashish M. Kamat, MD, at The 2018 Congreso de la Asociacion Mexicana de Urologia Oncologica – July 25-28, 2018, Acapulco, Guerrero.