Astellas’ Xtandi (ingredient: enzalutamide) drew much attention at the Korean Urological Association’s conference as it proved a therapeutic effect in all patients with metastatic hormone-sensitive prostate cancer (mHSPC) regardless of disease volume or risk groups.
Choi Seok-hwan, a professor at the Urology Department of Kyungpook National University Hospital, spoke on enzalutamide as a new treatment option for mHSPC patients at the conference held in COEX, southern Seoul, on Thursday. He shared the latest mHSPC treatment trends, and Xtandi’s efficacy was confirmed in clinical trials.
According to the ENZAMET study of Xtandi, the combination of Xtandi and androgen deprivation therapy (ADT) improved the overall survival (OS) and progression-free survival (PFS) in mHSPC patients, compared to the combo of another nonsteroid antiandrogen and ADT.
The risk of death fell by 33 percent, and the risk of prostate-specific antigen (PSA) progression was down 61 percent in the Xtandi plus ADT group.
Choi noted that Xtandi plus ADT combo could also be used in patients with visceral metastases or low-volume patients with four or more bone metastases, including one or more vertebral and extrapelvic metastases. “It is meaningful that the Xtandi and ADT combo significantly reduced the risk of disease progression and death in mHSPC patients regardless of the metastasis volume,” he said.
In the ARCHES study of Xtandi, the combo of Xtandi and ADT reduced the risk of radiographic progression-free survival (rPFS) by 61 percent compared to placebo plus ADT in mHSPC patients, regardless of disease volume or risk.
Choi also introduced the final analysis of the OS of ARCHES participants, released at the 2021 ESMO Virtual Congress on Sept. 16-21. The results showed that Xtandi plus ADT reduced the risk of death by 34 percent, compared to placebo plus ADT.
This signaled that the Xtandi plus ADT group could demonstrate positive OS outcome, compared to the control group, regardless of disease volume or risk, Choi said.
Based on this evidence, the 2021 U.S. National Comprehensive Cancer Network (NCCN) guidelines recommend Xtandi as Category 1 treatment for mHSPC. In addition, the European Association of Urology (EAU)’s guidelines recommend Xtandi for prostate cancer with distant metastasis.
“In general, the five-year relative survival rate for patients with local prostate cancer is almost 100 percent. But that of patients with distant metastases is only 44.9 percent,” Choi said. “I hope patients could benefit from a new effective treatment option to improve the survival rate of patients with metastatic prostate cancer who have a poor prognosis.”