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Enzalutamide vs. a Combination of Ra223 and Enzalutamide in Asymptomatic or Mildly Symptomatic Castration-Resistant Prostate Cancer Patients Metastatic to Bone (EORTC-1333-GUCG/PEACE III)

Curated by Clinicians: Educational Forum with Videos, Abstracts and Conference Information
Videos
Physician-Scientist Review Articles
State of the Evidence Review Articles
January 30, 2025
Bone metastases are at the center of advanced prostate cancer care, with over 90% of patients with metastatic prostate cancer expected to have bone involvement.1 These metastatic sites can be a cause of substantial pain in our patients, and they have been a key target for therapeutic development. Bone targeted agents have been developed to reduce fragility fractures and skeletal related events, and are now an integral part of the care of patients with metastatic prostate cancer,2,3 Further, radium-223 is a bone-targeted radiopharmaceutical that not only reduces pain burden but was also the first radiopharmaceutical to prolong survival in patients with prostate cancer. Over time prostate cancer studies have investigated the prognostic implications of bone metastases in comparison with other sites and helped us gain insight into the potential future progression or responsiveness of disease.4 Bone metastases have played a large role in the clinical care of patients with prostate cancer, and our approach to them continues to evolve.
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Fred Saad, MD, FRCS
The 2025 EAU annual meeting featured a prostate cancer session and a presentation by Dr. Fred Saad discussing a subgroup analysis of the PEACE 3 phase III trial assessing the impact of bone protecting agents on the efficacy and safety of enzalutamide versus combination of radium-223 and enzalutamide in asymptomatic or mildly symptomatic patients with bone metastatic castration-resistant prostate cancer (mCRPC). PEACE-3 was an international study in 446 patients with mCRPC and bone metastases randomized 1:1 to combination of enzalutamide and radium-223 versus enzalutamide alone:
Presented by Silke Gillessen Sommer, MD
(UroToday.com) The 2024 European Society for Medical Oncology (ESMO) Annual Congress held in Barcelona, Spain between September 13th and 16th, 2024 was host to a presidential symposium of practice-changing trials. Professor Silke Gillessen presented the initial results of EORTC-GUCG 1333/PEACE-3

Bayer will present new oncology data, including a late-breaking, comprehensive analysis from the Phase III ARANOTE trial investigating NUBEQA® (darolutamide) plus androgen deprivation therapy (ADT) in patients with metastatic hormone-sensitive prostate cancer (mHSPC), at the European Society for Medical Oncology (ESMO) Congress, taking place in Barcelona, Spain, from September 13-17, 2024.

Presented by Oliver Sartor, MD
The 2024 PSMA conference featured a presentation by Dr. Oliver Sartor discussing the role of radium-223 in the setting of PSMA PET. Dr. Sartor started by highlighting that based on the ALSYMPCA trial published in 2013,1 this was the first alpha emitter approved in all of medicine.
Presented by Silke Gillessen, MD
Bone strengthening agents such as bisphosphonates or the RANKL-targeting antibody denosumab reduced the bone loss associated with androgen deprivation therapy (ADT) and prevent skeletal-related events in castration resistant prostate cancer (CRPC). The use of these agents is recommended in CRPC by many guidelines.
Presented by Silke Gillessen, MD
Beginning with the introduction of docetaxel for metastatic castration resistant prostate cancer (mCRPC) in 2004, there has been a dramatic and rapid proliferation of systemic therapy options in advanced prostate cancer including a number of novel hormonal therapies (including abiraterone acetate and enzalutamide),
Presented by Bertrand F. Tombal, MD, PhD
Skeletal fractures, pathological or not, are a frequent and underestimated side-effect of systemic treatment of metastatic castration-resistant prostate cancer (mCRPC). The ERA223 trial randomized 806 patients with chemotherapy-naïve, mCRPC with bone metastasis to radium-223 or placebo, in addition to abiraterone acetate.
Presented by Bertrand Tombal, MD, PhD
Dr. Bertrand Tombal and colleagues presented the trial design for PEACE III, enzalutamide vs. a combination of radium-223 (Ra-223) and enzalutamide in asymptomatic or mildly symptomatic CRPC patients metastatic to bone. The α-emitting radiopharmaceutical Ra-223 reduced the risk of death by 30% vs placebo in the phase III ALSYMPCA trial.1