A randomised, double-blind study comparing the addition of bicalutamide with or without dutasteride to GnRH analogue therapy in men with non-metastatic castrate-resistant prostate cancer.

BACKGROUND - Bicalutamide blocks androgen action and is frequently used in men with non-metastatic, castration-resistant prostate cancer (CRPC). By reducing intracellular dihydrotestosterone, dutasteride (dual 5-alpha reductase inhibitor) could increase the effectiveness of bicalutamide in this setting. The objective of the study is therefore to prospectively evaluate dutasteride plus bicalutamide in men with asymptomatic, non-metastatic CRPC with rising prostate-specific antigen (PSA).

METHODS - Prostate cancer patients with rising PSA whilst on first-line androgen deprivation therapy (ADT) were randomised (1:1) in a double-blind trial to receive bicalutamide 50mg plus placebo or bicalutamide 50mg plus dutasteride 3.5mg once daily for 18months. Randomisation was stratified by centre; treatment assignments were generated using GlaxoSmithKline's RandAll System. Subjects who completed 18months could participate in the 2-year extension. Central laboratory and study sites/monitors remained treatment-blinded. Primary end-point was time to disease progression (TDP) up to 42months (defined as PSA progression from baseline or nadir, radiographic disease progression, death from prostate cancer or receipt of rescue medication).

FINDINGS - There was no statistically significant difference in TDP in 127 men treated with bicalutamide/dutasteride (n=62) compared with bicalutamide/placebo (n=65) (hazard ratio (HR)=0.94 [95% confidence interval (CI) 0.61, 1.46]; p=0.79). The estimated median TDP was 425days (95% CI 302, 858) in the bicalutamide/placebo group and 623days (95% CI 369, 730) in the bicalutamide/dutasteride group. There was no statistically significant difference between the treatment groups for any secondary efficacy end-points, including time to treatment failure or PSA response. In the multivariate analysis, age, non-White race, higher baseline testosterone and lower baseline PSA were associated with longer TDP. Adverse events were comparable between treatment groups.

INTERPRETATION - In men with non-metastatic CRPC, adding dutasteride to bicalutamide did not significantly prolong TDP. Prospective data are provided concerning the common practice of using bicalutamide in this setting.

Eur J Cancer. 2015 Aug;51(12):1555-69. doi: 10.1016/j.ejca.2015.04.028. Epub 2015 Jun 2.

Chu FM1, Sartor O2, Gomella L3, Rudo T4, Somerville MC5, Hereghty B5, Manyak MJ5.

1 San Bernardino Urological Associates, 489 E. 21 Street, San Bernardino, CA 92404, USA.
2 Medicine and Urology Departments, Tulane School of Medicine, Box SL-42 1430 Tulane Ave, New Orleans, USA.
3 Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA.
4 GlaxoSmithKline, 1250 S Collegeville Rd, Collegeville, PA 19426, USA.
5 GlaxoSmithKline, 5 Moore Drive, PO Box 13398, Research Triangle Park, North Carolina, NC 27709, USA.