Enzalutamide Helps Extend Life for Men with Advanced Prostate Cancer
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DURHAM, N.C. – The combination of enzalutamide with androgen deprivation therapy (ADT) significantly increases the chance of five-year survival for men with metastatic hormone-sensitive prostate cancer, according to a five-year follow-up of the global ARCHES study led by the Duke Cancer Institute.
The five-year survival rate improved by 13% for men with high-volume disease, which occurs in patients with five or more bone metastases or cancer that has spread to the liver or lungs. These patients typically have the shortest survival after diagnosis.
The study found the combination therapy extended the lives of patients with high-volume disease by three additional years, from approximately four to now seven years. The survival rate also improved by 9% in patients with low-volume disease, and more than 75% of such men lived beyond five years with this new treatment.
“We haven’t seen that kind of median improvement in any trial in prostate cancer. Having three extra years of life on average is huge for our patients,” said lead author Andrew Armstrong, M.D., professor in the Department of Medicine at Duke University School of Medicine. “These data show that with more intensive treatment, patients can stay in remission, enjoy a good quality of life, keep their disease under control and live to reach key milestones.”
The FDA approved enzalutamide for patients with castration-resistant prostate cancer in 2019 following the results of the ARCHES clinical trial. The study enrolled 1,150 men at sites worldwide. Participants were randomized into two groups — half received the combination therapy and half received ADT and a placebo.
At five years, men treated with enzalutamide and ADT had a 66% chance of survival compared with 53% for men treated with hormones alone. The risk of death dropped by 30% in patients treated with the more intensive hormonal therapy compared with the placebo group.
Enzalutamide works by blocking the androgen receptor, helping stop testosterone from allowing cancer cells to survive and grow. It was found to help people live longer regardless of age, how extensively the cancer has spread, previous treatments like chemotherapy, or when the cancer reached other parts of the body like lymph nodes or bone.
“This survival analysis reveals the long-term benefits of treating metastatic hormone-sensitive prostate cancer with enzalutamide and ADT in combination,” Armstrong said. “It shows that all patients should be offered treatment intensification from the beginning. They shouldn’t be offered the old way of doing hormonal therapy with ADT alone except in rare circumstances. Treatment intensification is now the standard of care.”
The five-year overall survival results will be presented June 3 at the American Society of Clinical Oncology annual meeting in Chicago.
In addition to Armstrong, study authors include Daniel P. Petrylak, Neal D. Shore, Russell Z. Szmulewitz, Jeffrey Holzbeierlein, Arnauld Villers, Antonio Alcaraz, Boris Alekseev, Taro Iguchi, Francisco Gomez-Veiga, Ruslan Croitoru, Ruishan Wu, Matko Kalac, Yiyun Tang, Arnulf Stenzl, and Arun A. Azad.