Enzalutamide, a potent androgen-receptor inhibitor, has demonstrated significant benefits in metastatic and nonmetastatic castration-resistant prostate cancer. We evaluated the efficacy and safety of enzalutamide in metastatic hormone-sensitive prostate cancer (mHSPC).

ARCHES (ClinicalTrials.gov identifier: NCT02677896) is a multinational, double-blind, phase III trial, wherein 1,150 men with mHSPC were randomly assigned 1:1 to enzalutamide (160 mg/day) or placebo, plus androgen deprivation therapy (ADT), stratified by disease volume and prior docetaxel chemotherapy. The primary end point was radiographic progression-free survival.

As of October 14, 2018, the risk of radiographic progression or death was significantly reduced with enzalutamide plus ADT versus placebo plus ADT (hazard ratio, 0.39; 95% CI, 0.30 to 0.50; P < .001; median not reached v 19.0 months). Similar significant improvements in radiographic progression-free survival were reported in prespecified subgroups on the basis of disease volume and prior docetaxel therapy. Enzalutamide plus ADT significantly reduced the risk of prostate-specific antigen progression, initiation of new antineoplastic therapy, first symptomatic skeletal event, castration resistance, and reduced risk of pain progression. More men achieved an undetectable prostate-specific antigen level and/or an objective response with enzalutamide plus ADT (P < .001). Patients in both treatment groups reported a high baseline level of quality of life, which was maintained over time. Grade 3 or greater adverse events were reported in 24.3% of patients who received enzalutamide plus ADT versus 25.6% of patients who received placebo plus ADT, with no unexpected adverse events.

Enzalutamide with ADT significantly reduced the risk of metastatic progression or death over time versus placebo plus ADT in men with mHSPC, including those with low-volume disease and/or prior docetaxel, with a safety analysis that seems consistent with the safety profile of enzalutamide in previous clinical trials in castration-resistant prostate cancer.

Globally, prostate cancer was the most common cancer for men, with 1.4 million patients in 2016; mortality was 381,000.1 In the United States, 174,650 new cases of prostate cancer are expected in 2019, with 31,620 anticipated deaths.2 The majority of deaths from prostate cancer are due to metastatic disease, identified either at diagnosis or after relapse following local therapies.3

Metastatic hormone-sensitive prostate cancer (mHSPC), defined as patients with metastatic disease who have not yet received, or are continuing to respond to, hormone therapy, accounts for up to 5% of annual prostate cancer incidence in the United States.4 Androgen deprivation therapy (ADT) with a luteinizing hormone-releasing hormone agonist/receptor antagonist or bilateral orchiectomy has been the standard of care (SOC) for men with mHSPC.5 However, the majority of men with mHSPC who receive ADT alone progress to castration-resistant disease within 1 to 3 years, despite experiencing an initial response.5-7

Previous trials in men with mHSPC combining ADT with other treatments such as docetaxel chemotherapy6,8 or the selective androgen biosynthesis inhibitor abiraterone acetate,9-11 hereafter referred to as abiraterone, have demonstrated significant clinical benefits, including significantly improved overall survival (OS), and these combinations are now included in treatment guidelines as part of the SOC.12,13 Abiraterone plus ADT is approved in combination with prednisone for men with metastatic high-risk castration-sensitive prostate cancer,14,15 on the basis of the LATITUDE trial (ClinicalTrials.gov identifier: NCT01715285),10 which exclusively enrolled men with high-risk mHSPC and excluded previous chemotherapy.

The efficacy and safety of enzalutamide, a potent androgen-receptor (AR) inhibitor,16 has been demonstrated across the spectrum of castration-resistant prostate cancer (CRPC) by numerous, large-scale, randomized, controlled clinical trials.17-21 In addition, a phase II, open-label, single-arm study investigating enzalutamide monotherapy in patients with hormone-naïve prostate cancer demonstrated long-term reductions in prostate-specific antigen (PSA) levels, with minimal changes in overall bone mineral density and global health status.22-24

Two recent studies that investigated abiraterone in addition to ADT excluded men with prior docetaxel chemotherapy and did not include prospective evaluation of results by disease volume (high v low).10,11 ARCHES (ClinicalTrials.gov identifier: NCT02677896) aimed to assess efficacy and safety of enzalutamide plus ADT in men with mHSPC, regardless of prior docetaxel or disease volume. We hypothesized that enzalutamide, in combination with ADT, would prolong radiographic progression-free survival (rPFS) in men with mHSPC, compared with ADT alone.

Study Design and Conduct

ARCHES is a multinational, double-blind, randomized, placebo-controlled, phase III trial. The study protocol was approved by local independent review boards and conducted according to provisions of the Declaration of Helsinki and Good Clinical Practice Guidelines of the International Conference on Harmonisation. All patients provided written informed consent. An independent Data Safety Monitoring Board (DSMB) evaluated unblinded safety data on an ongoing basis. Please refer to the Disclosures for full information on data sharing.

Patients and Treatments

Eligible patients were adult (defined according to local regulation) males with pathologically confirmed prostate adenocarcinoma, without neuroendocrine differentiation, signet-cell, or small-cell features, and an Eastern Cooperative Oncology Group performance status score of 0 or 1. Eligible patients had hormone-sensitive metastatic disease, either de novo or after recurrence after prior local therapy, documented by a positive bone scan, or metastatic lesions on computed tomography or magnetic resonance imaging. Enrollment was based on investigator-assessed metastases; after study entry, metastasis was evaluated by independent central review. Prior ADT and up to six cycles of prior docetaxel chemotherapy were permitted. Patients who experienced disease progression prior to randomization while receiving ADT and/or docetaxel were excluded. Additional details regarding inclusion/exclusion criteria are provided in the Data Supplement.

Patients were centrally randomized 1:1 to enzalutamide (160 mg/day) plus ADT or placebo plus ADT, stratified by disease volume (low v high) and prior docetaxel chemotherapy for prostate cancer (no cycles, one to five cycles, or six cycles). High-volume disease was defined as presence of metastases involving the viscera, or in the absence of visceral lesions, four or more bone lesions, one or more of which must have been in a bony structure beyond the vertebral column and pelvic bone, per CHAARTED (ClinicalTrials.gov identifier: NCT00309985) criteria.6 Treatment continued until occurrence of unacceptable toxicity, radiographic progression (confirmed by independent central review), or initiation of an investigational agent or new prostate cancer therapy. Subsequent therapy after treatment discontinuation was permitted per local practice. On the basis of the primary analysis results and DSMB recommendation of study continuation, eligible patients were offered the opportunity to transition to an open-label extension.

End Points

The primary end point was rPFS, defined as the time from randomization to the first objective evidence of radiographic disease progression, as assessed by independent central review or death (defined as death from any cause within 24 weeks from study drug discontinuation), whichever occurred first. The cutoff of 24 weeks from study drug discontinuation (ie, the second long-term follow-up visit) for deaths (in the absence of disease progression) ensured a similar follow-up period as for monitoring of radiographic progression (ie, two 12-week radiologic assessment cycles post-treatment discontinuation). In addition, sensitivity analyses for rPFS were performed, including all deaths (in the absence of evidence of radiographic progression) regardless of timing, and radiographic progression documented by central review according to Prostate Cancer Working Group 2 criteria,25 to assess the robustness of the primary analysis; additional details are provided in Data Supplement Table A1. Key secondary end points were time to PSA progression, time to initiation of new antineoplastic therapy (including cytotoxic and hormone therapies), PSA undetectable rate, objective response rate, time to deterioration in urinary symptoms, and OS. Other secondary end points included time to first symptomatic skeletal event, time to castration resistance, patient-reported outcomes (PROs), time to deterioration of quality of life (QoL), and time to pain progression. Additional prespecified analyses, per a separate PRO statistical analysis plan (SAP), included QoL over time and sensitivity analyses of time to pain progression (using other clinically meaningful threshold criteria). Safety was also assessed. End point definitions are provided in Data Supplement Table A1.

Assessments

Efficacy assessments included sequential radiographic imaging performed at screening, at week 13, and every subsequent 12 weeks. Radiographic progression events were confirmed by independent central review; details regarding the definition of radiographic progression, including confirmatory scans required for new bone lesions observed over time, are provided in Data Supplement Table A2. PSA levels were measured at screening, at weeks 1, 5, and 13, every subsequent 12 weeks, and 30 days after the last dose or prior to initiation of new antineoplastic therapy for prostate cancer, whichever occurred first. PRO assessments, such as Functional Assessment of Cancer Therapy–Prostate,26 Quality of Life Prostate-Specific questionnaire 25,27 and Brief Pain Inventory–Short Form (BPI-SF), were completed at baseline, week 13, and every 12 weeks thereafter. Adverse events (AEs) were graded by the investigator according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03).

Statistical Analysis

The final rPFS analysis was planned to occur after 262 events, to detect a hazard ratio (HR) of 0.67 with 90% power, on the basis of a two-sided log-rank test and 5% significance level. To adjust for multiplicity, a parallel testing strategy was applied to the key secondary end points (Appendix Fig A1, online only). Key secondary end points, other than OS, were sequentially tested at a 1% significance level. A final OS analysis will be performed when 342 deaths have occurred to provide 80% power to detect an HR of 0.73 at a 4% significance level. An interim OS analysis was performed at the time of the final rPFS analysis at a significance level calculated using the O’Brien-Fleming function to control the overall alpha. Additional details regarding the statistical analyses (original and final) are provided in the Data Supplement (Fig A1 and Table A1) and Protocol (including SAP).

Patients and Treatment

From March 21, 2016, to January 12, 2018, a total of 1,150 patients were randomly assigned 1:1 from 202 centers in North and Latin America, Europe, and Asia; 1,146 patients received at least one dose of the study drug (Fig 1). Baseline demographics were well balanced between treatment groups (Table 1); 727 patients (63.2%) had high-volume disease, and 205 (17.9%) received prior docetaxel chemotherapy. Use of concomitant antiandrogens as prostate cancer therapy during the study was reported by 34 patients (5.9%) in the enzalutamide plus ADT group and 43 patients (7.5%) in the placebo plus ADT group.

Table

TABLE 1. Baseline Demographics

As of the data cutoff on October 14, 2018, median follow-up time was 14.4 months. Overall, 377 patients (32.8%) discontinued study treatment (enzalutamide plus ADT, n = 135 [23.5%]; placebo plus ADT, n = 242 [42.0%]). The primary reason for treatment discontinuation was progressive disease (enzalutamide plus ADT, n = 65 [11.3%] v placebo plus ADT, n = 171 [29.7%]), followed by patient withdrawal (n = 25 [4.4%] v n = 30 [5.2%], respectively; Fig 1).

rPFS

At data cutoff, 292 radiographic disease progression events or deaths without radiographic disease progression within 24 weeks of treatment discontinuation had occurred (enzalutamide plus ADT, n = 91 [15.9%]; placebo plus ADT, n = 201 [34.9%]; Table 2). Overall, enzalutamide plus ADT significantly reduced the risk of radiographic disease progression or death compared with placebo plus ADT by 61% (HR, 0.39; 95% CI, 0.30 to 0.50; P < .001; Fig 2A). Median rPFS was not reached (NR) with enzalutamide plus ADT (95% CI, NR to NR) versus 19.0 months (95% CI, 16.6 to 22.2 months) with placebo plus ADT. The treatment effect of enzalutamide plus ADT was consistent across all prespecified subgroups, including disease volume and prior docetaxel chemotherapy (Fig 2B). A sensitivity analysis of rPFS, including all deaths (in the absence of evidence of radiographic disease progression) regardless of timing, and a sensitivity analysis of radiographic progression documented by central review according to Prostate Cancer Working Group 2 criteria25 were both consistent with the primary analysis (Table 2).

Table

TABLE 2. Primary and Secondary End Points

Secondary End Points

The superiority of enzalutamide plus ADT over placebo plus ADT was shown for the key secondary end points of time to PSA progression, time to initiation of new antineoplastic therapy, PSA undetectable rate, and objective response rate (Table 2; Fig 3). Although the median time to initiation of a new antineoplastic agent of 30.2 months in the enzalutamide arm is not a reliable estimate because it resulted from an event observed in the only remaining patient at risk, the treatment effect was robust, as evidenced by the HR of 0.28 (95% CI, 0.20 to 0.40; P < .001). Of the patients who initiated new antineoplastic therapy, the most common therapy was abiraterone (n = 13; 28.3%) followed by docetaxel (n = 11; 23.9%) in the enzalutamide plus ADT group and docetaxel (n = 52; 39.1%) followed by abiraterone and enzalutamide (n = 28 each; 21.1%) in the placebo plus ADT group (Data Supplement Table A3). At this interim OS analysis, data were immature, with 84 deaths (enzalutamide plus ADT, n = 39; placebo plus ADT, n = 45); median duration of OS was NR in either treatment group (HR, 0.81; 95% CI, 0.53 to 1.25; P = .3361; Table 2; Data Supplement Fig A2). Enzalutamide plus ADT also significantly reduced the risk of a first symptomatic skeletal event (Table 2; Fig 3) and castration resistance (Table 2; Data Supplement Fig A3).

Mean Functional Assessment of Cancer Therapy–Prostate total score, as a global indicator of QoL, was high at baseline for both treatment groups (Table 1) and remained high over time (Data Supplement Fig A4). Enzalutamide plus ADT did not significantly affect time to deterioration in urinary symptoms or QoL compared with placebo plus ADT (Table 2). Although the analysis of time to pain progression, with progression defined as a 30% or greater increase from baseline in average BPI-SF pain severity score, was not delayed (Table 2), prespecified sensitivity analyses from the PRO SAP, using a clinically significant 2-point or greater increase from baseline in average BPI-SF score as the progression threshold, demonstrated that enzalutamide plus ADT delayed time to pain progression for worst pain and pain severity versus placebo plus ADT (Table 2; Data Supplement Fig A5).

Safety

Median treatment duration was 12.8 months (range, 0.2 to 26.6 months) in the enzalutamide plus ADT group and 11.6 months (range, 0.2 to 24.6 months) in the placebo plus ADT group. Grade 3 or greater AEs, serious AEs, and AEs leading to treatment discontinuation were reported in similar proportions of patients in both treatment groups (Table 3). There were no unexpected AEs; of the 14 AEs (2.4%) leading to death in the enzalutamide plus ADT group and 10 (1.7%) in the placebo plus ADT group, none were assessed by the investigator to be related to treatment in the enzalutamide plus ADT group, whereas one event (general physical health deterioration) was assessed by the investigator to be related in the placebo plus ADT group.

Table

TABLE 3. Summary of AEs

In this phase III trial involving men with mHSPC, adding enzalutamide to ADT significantly reduced the risk of radiographic disease progression or death by 61% compared with placebo plus ADT (HR, 0.39; P < .001). Significant improvements with enzalutamide plus ADT were also observed in secondary efficacy end points. OS data are immature and will be analyzed when 342 deaths have occurred. Preliminary safety analysis showed an acceptable safety profile that seems consistent with that in previously reported clinical trials involving patients with CRPC,17,18 with maintenance of QoL at the high level reported at baseline. These efficacy and safety results prompted the DSMB to recommend crossing patients treated with placebo plus ADT over to enzalutamide plus ADT.

Importantly, the significant reduction in the risk of radiographic disease progression or death with enzalutamide plus ADT in this study (P < .001) was observed in all prespecified subgroups, including men with or without prior docetaxel chemotherapy and those with a low or high volume of metastatic disease. These data support the consideration of enzalutamide in addition to ADT for men with mHSPC, including patients with prior docetaxel treatment and regardless of disease volume. Although OS data remain immature, these findings have clear clinical implications for the current management of these patients.

PROs from assessments of daily living have also been shown to predict survival in prostate cancer.29 In this population of men with mHSPC, we observed maintenance of high QoL over time, similar to that observed in the population with nonmetastatic castration-resistant disease.30 Baseline average BPI-SF scores were low overall, with almost half of patients reporting scores of zero. Consequently, no significant difference between treatment groups in risk of pain progression, defined as a 30% or greater increase in average BPI-SF pain severity score, was observed. However, when using a more clinically meaningful definition of pain progression (≥ 2-point threshold)31 during the prespecified sensitivity analyses from the PRO SAP, enzalutamide plus ADT showed a delay in pain progression versus placebo plus ADT. Ultimately, no significant difference between treatment groups in risk of deterioration of urinary symptoms or QoL was observed, suggesting there was no negative impact on PROs due to the addition of enzalutamide to ADT. Additional analyses of the PROs are ongoing and are also planned as part of the long-term follow-up.

Currently, ARCHES is the first trial to demonstrate clinically meaningful benefits of potent AR inhibition with a second-generation nonsteroidal antiandrogen (enzalutamide) in combination with ADT, including a subgroup of men with mHSPC after docetaxel chemotherapy. Whereas some previous studies focused on patients with high risk and entirely excluded patients with previous chemotherapy,6-8,10,11 the specific inclusion of patients with prior docetaxel chemotherapy in ARCHES provides unique insight into this important patient subgroup with unmet clinical needs.

Both rPFS and metastasis-free survival are accepted by the US Food and Drug Administration as primary efficacy end points in metastatic CRPC and nonmetastatic CRPC, respectively.32,33 However, although rPFS has not yet been established as a surrogate for OS in mHSPC, it is an acceptable regulatory end point, and reducing the risk of radiographic progression or death is of clinical importance, given the strong positive correlation reported for rPFS and OS in patients with metastatic CRPC34,35 and the direct impact of additional metastatic progression in this setting on patient management. Furthermore, rPFS requires shorter follow-up periods and fewer patients compared with OS as a result of the higher event rate, accelerating trial completion.36 It is also in the interest of patients to unblind trials earlier, on the basis of robust rPFS evidence, especially when supported by strong secondary end points, to allow crossover to active treatment. Therefore, ARCHES was accelerated, with rPFS analysis conducted after only 262 events, despite an immature OS analysis. At the time of manuscript submission, a phase III study investigating the addition of enzalutamide versus a first-generation nonsteroidal antiandrogen, such as bicalutamide, to ADT, with or without docetaxel chemotherapy, in men with mHSPC37 is currently ongoing and will provide additional data on the clinical benefits of enzalutamide plus ADT, including the impact on OS.

Several therapies have recently been shown to be effective in men with mHSPC; therefore, ADT alone may no longer be an appropriate control arm in this patient population. However, docetaxel plus ADT only became part of the global SOC for mHSPC in 2016, after patients were already enrolling in ARCHES,12 and thus, docetaxel could not have been considered as part of the comparator arm in the current study. Furthermore, patients with high-volume disease who had completed prior docetaxel were eligible for trial entry by study design, and for those with low-volume disease, the benefit of early treatment with docetaxel combined with ADT has not been established.13,38,39

In conclusion, in comparison with placebo, the addition of enzalutamide to ADT for men with mHSPC provided clinically meaningful improvements across key efficacy end points while maintaining the high level of QoL reported at baseline. Enzalutamide was generally well tolerated, with a preliminary safety analysis seeming to be consistent with the safety profile of enzalutamide in previous clinical trials in CRPC. Enzalutamide plus ADT should therefore be considered as a treatment option for men with mHSPC, including those with low-volume disease or who had received prior docetaxel. Additional studies are necessary to clarify whether combination or sequential approaches with AR-targeted therapies or chemotherapy are favored for initial management.

© 2019 by American Society of Clinical Oncology

Presented in part at the ASCO 2019 Genitourinary Cancers Symposium, San Francisco, CA, February 14 to 16, 2019; and European Association of Urology 2019 Annual Congress, Barcelona, Spain, March 15 to 19, 2019.

Supported by Astellas Pharma and Pfizer.

See accompanying Editorial on page 2957

See accompanying article on page 2961

Clinical trial information: NCT02677896.

Conception and design: Andrew J. Armstrong, Benoit Baron

Provision of study materials or patients: Andrew J. Armstrong, Russell Z. Szmulewitz, Daniel P. Petrylak, Jeffrey Holzbeierlein, Arnauld Villers, Arun Azad, Antonio Alcaraz, Boris Alekseev, Taro Iguchi, Neal D. Shore, Lucy Chen, Arnulf Stenzl

Collection and assembly of data: Andrew J. Armstrong, Russell Z. Szmulewitz, Arnauld Villers, Arun Azad, Antonio Alcaraz, Boris Alekseev, Lucy Chen, Arnulf Stenzl

Data analysis and interpretation: Andrew J. Armstrong, Russell Z. Szmulewitz, Daniel P. Petrylak, Jeffrey Holzbeierlein, Arnauld Villers, Arun Azad, Antonio Alcaraz, Boris Alekseev, Taro Iguchi, Neal D. Shore, Brad Rosbrook, Jennifer Sugg, Benoit Baron, Lucy Chen, Arnulf Stenzl

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

ARCHES: A Randomized, Phase III Study of Androgen Deprivation Therapy With Enzalutamide or Placebo in Men with Metastatic Hormone-Sensitive Prostate Cancer

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc.

Andrew J. Armstrong

Honoraria: Sanofi, Dendreon, Janssen Oncology

Consulting or Advisory Role: Bayer, Sanofi, Dendreon, Medivation, Janssen Biotech, Pfizer, Astellas Scientific and Medical Affairs, Clovis Oncology, AstraZeneca

Speakers' Bureau: Dendreon, Sanofi, Bayer

Research Funding: Dendreon (Inst), Sanofi (Inst), Bayer (Inst), Pfizer (Inst), Novartis (Inst), Janssen Oncology (Inst), Medivation (Inst), Astellas Pharma (Inst), Gilead Sciences (Inst), Genentech (Inst), Active Biotech (Inst), Bristol-Myers Squibb (Inst)

Patents, Royalties, Other Intellectual Property: Circulating tumor cell novel capture technology (Inst)

Travel, Accommodations, Expenses: Dendreon, Janssen Biotech, Bayer, Astellas Scientific and Medical Affairs

Russell Z. Szmulewitz

Honoraria: Astellas Pharma

Consulting or Advisory Role: AstraZeneca, AbbVie, Exelixis, Merck, Amgen, Janssen Oncology, Sanofi, Astellas Pharma, Pfizer

Research Funding: AbbVie, Astellas Pharma, Incyte, Macrogenics, Janssen Oncology

Patents, Royalties, Other Intellectual Property: Patent licensed by University of Chicago of which I am co-inventor to Corcept Therapeutics for combination AR/GR inhibition in prostate cancer

Travel, Accommodations, Expenses: Corcept Therapeutics

Daniel P. Petrylak

Stock and Other Ownership Interests: Bellicum Pharmaceuticals, Tyme

Consulting or Advisory Role: Bayer, Exelixis, Pfizer, Roche, Astellas Pharma, AstraZeneca, Lilly, Ada Cap, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis Oncology, Incyte, Janssen, Pharmacyclics, Seattle Genetics, Urogen Pharma

Research Funding: Progenics (Inst), Sanofi (Inst), Endocyte (Inst), Genentech (Inst), Merck (Inst), Astellas Medivation (Inst), Novartis (Inst), AstraZeneca (Inst), Bayer (Inst), Lilly (Inst), Innocrin Pharma (Inst), MedImmune (Inst), Pfizer (Inst), Roche (Inst), Seattle Genetics (Inst), Clovis Oncology (Inst), Ada Cap (Inst), Bristol-Myers Squibb (Inst)

Expert Testimony: Celgene, Sanofi

Jeffrey Holzbeierlein

Research Funding: Astellas Pharma (Inst), MDxHealth (Inst)

Arnauld Villers

Consulting or Advisory Role: Astellas Pharma

Research Funding: Astellas Pharma (Inst), Ipsen (Inst)

Travel, Accommodations, Expenses: Astellas Pharma, Janssen-Cilag

Arun Azad

Honoraria: Janssen, Astellas Pharma, Novartis, Tolmar, Amgen, Pfizer, Bayer, Telix Pharmaceuticals

Consulting or Advisory Role: Astellas Pharma, Novartis, Janssen, Sanofi, AstraZeneca, Pfizer, Bristol-Myers Squibb, Tolmar, Telix Pharmaceuticals

Speakers' Bureau: Astellas Pharma, Novartis, Amgen, Bayer

Research Funding: Astellas Pharma, Merck Serono (Inst)

Travel, Accommodations, Expenses: Astellas Pharma, Sanofi, Merck Serono

Antonio Alcaraz

Travel, Accommodations, Expenses: Astellas, Olympus, Ipsen, Janssen, Bayer

Boris Alexeev

Consulting or Advisory Role: AstraZeneca, Astellas Pharma, Bayer, Bristol-Myers Squibb, Ferring, Janssen, Merck, Sanofi, Pfizer

Speakers' Bureau: Janssen, Sanofi, Ferring, Astellas Pharma, Pfizer, AstraZeneca, Bayer, Merck, Bristol-Myers Squibb

Research Funding: AstraZeneca, Merck, Sanofi, Bayer, Astellas Pharma, Janssen, Bristol-Myers Squibb, Bavarian Nordic, Pfizer, Icon Clinical Research

Travel, Accommodations, Expenses: AstraZeneca, Astellas, Bayer, BMS, Janssen, MSD, Pfizer, Sanofi

Taro Iguchi

Consulting or Advisory Role: Astellas Pharma, Bayer Yakuhin, Janssen Pharmaceutical

Speakers' Bureau: Astellas Pharma, Bayer Yakuhin, Janssen Pharmaceutical, Sanofi

Research Funding: Astellas Pharma, Bayer Yakuhin

Neal D. Shore

Consulting or Advisory Role: Bayer, Janssen Scientific Affairs, Dendreon, Tolmar, Ferring, Medivation/Astellas, Amgen, Pfizer, AstraZeneca, Genentech, Myovant Sciences

Speakers' Bureau: Janssen, Bayer, Dendreon

Brad Rosbrook

Employment: Pfizer

Stock and Other Ownership Interests: Pfizer

Jennifer Sugg

Employment: Astellas Pharma

Stock and Other Ownership Interests: AstraZeneca

Benoit Baron

Employment: Astellas Pharma (during conduct of the study)

Consulting or Advisory Role: Astellas Pharma

Travel, Accommodations, Expenses: Astellas Pharma

Lucy Chen

Employment: Astellas Pharma

Honoraria: Abbvie (I), Reflexion Medical (I)

Consulting or Advisory Role: AbbVie (I), Reflexion Medical (I)

Travel, Accommodations, Expenses: AbbVie (I), Reflexion Medical (I)

Arnulf Stenzl

Consulting or Advisory Role: Ipsen Pharma, Roche, Janssen, Alere, Bristol-Myers-Squibb, Stebabiotech

Research Funding: Karl Storz AG, Astellas Pharma, AstraZeneca, Medivation, Janssen

Patents, Royalties, Other Intellectual Property: Patent A290/99: Implantable incontinence device; AT00/0001: C-Trap, implantable device to treat urinary incontinence; 2018/6579: Gene-expression signature for subtype and prognostic prediction of renal cell carcinoma

Expert Testimony: GBA photodynamic therapy of prostate cancer

Travel, Accommodations, Expenses: Janssen, Ipsen Pharma, Sanofi Aventis, CureVac, Ferring

No other potential conflicts of interest were reported.

ACKNOWLEDGMENT

The senior academic authors and employees of the study sponsors were responsible for the study design. Data analyses were performed by the study sponsors and provided to all authors. A professional medical writer, funded by the sponsors, assisted in the preparation of the manuscript. All authors had full access to the data, were involved in drafting the manuscript, and made the decision to submit it for publication. The authors assume responsibility for the accuracy and completeness of the data and for the adherence of the trial to the protocol. All of the authors and participating institutions have agreements with the sponsors regarding data confidentiality. We thank the patients who volunteered to participate in this trial and the investigators and trial staff who cared for them; and Stephanie Rippon, MBio, and Lauren Smith from Complete HealthVizion, for medical writing and editing assistance, funded by the sponsor companies.

Access to anonymized, individual, participant-level data collected during the trial, in addition to supporting clinical documentation, is planned for trials conducted with approved product indications and formulations, as well as compounds terminated during development. Conditions and exceptions are described under the Sponsor Specific Details for Astellas on www.clinicalstudydatarequest.com. Study-related supporting documentation is redacted and provided if available, such as the protocol and amendments, statistical analysis plan, and clinical study report. Access to participant-level data is offered to researchers after publication of the primary manuscript (if applicable) and is available as long as Astellas has legal authority to provide the data. Researchers must submit a proposal to conduct a scientifically relevant analysis of the study data. The research proposal is reviewed by an Independent Research Panel. If the proposal is approved, access to the study data is provided in a secure data-sharing environment after receipt of a signed Data-Sharing Agreement.

1. Fitzmaurice C, Akinyemiju TF, Al Lami FH, et al: Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: A systematic analysis for the global burden of disease study. JAMA Oncol 4:1553-1568, 2018 Crossref, MedlineGoogle Scholar
2. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2019. CA Cancer J Clin 69:7-34, 2019 Crossref, MedlineGoogle Scholar
3. Helgstrand JT, Røder MA, Klemann N, et al: Diagnostic characteristics of lethal prostate cancer. Eur J Cancer 84:18-26, 2017 Crossref, MedlineGoogle Scholar
4. Scher HI, Solo K, Valant J, et al: Prevalence of prostate cancer clinical states and mortality in the United States: Estimates using a dynamic progression model. PLoS One 10:e0139440, 2015 Crossref, MedlineGoogle Scholar
5. Fizazi K, Jenkins C, Tannock IF: Should docetaxel be standard of care for patients with metastatic hormone-sensitive prostate cancer? Pro and contra. Ann Oncol 26:1660-1667, 2015 CrossrefGoogle Scholar
6. Sweeney CJ, Chen YH, Carducci M, et al: Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373:737-746, 2015 Crossref, MedlineGoogle Scholar
7. Gravis G, Fizazi K, Joly F, et al: Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): A randomised, open-label, phase 3 trial. Lancet Oncol 14:149-158, 2013 Crossref, MedlineGoogle Scholar
8. James ND, Sydes MR, Clarke NW, et al: Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): Survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 387:1163-1177, 2016 Crossref, MedlineGoogle Scholar
9. de Bono JS, Logothetis CJ, Molina A, et al: Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 364:1995-2005, 2011 Crossref, MedlineGoogle Scholar
10. Fizazi K, Tran N, Fein L, et al: Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 377:352-360, 2017 Crossref, MedlineGoogle Scholar
11. James ND, de Bono JS, Spears MR, et al: Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med 377:338-351, 2017 Crossref, MedlineGoogle Scholar
12. Mottet N, van den Bergh RCN, Briers E, et al: EAU Guidelines. Presented at the EAU Annual Congress Copenhagen, Denmark, March 16 to 20, 2018 (ed 2018). Arnhem, The Netherlands, EAU Guidelines Office, 2018. https://uroweb.org/wp-content/uploads/EAU-ESUR-ESTRO-SIOG-Guidelines-on-Prostate-Cancer-large-text-V2.pdf Google Scholar
13. National Comprehensive Cancer Network: NCCN Clinical practice guidelines in oncology (NCCN Guidelines). Prostate cancer. Version 4. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf Google Scholar
14. Zytiga (abiraterone acetate) highlights of prescribing information. http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/ZYTIGA-pi.pdf Google Scholar
15. Zytiga (abiraterone acetate) summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/zytiga-epar-product-information_en.pdf Google Scholar
16. Tran C, Ouk S, Clegg NJ, et al: Development of a second-generation antiandrogen for treatment of advanced prostate cancer. Science 324:787-790, 2009 Crossref, MedlineGoogle Scholar
17. Beer TM, Armstrong AJ, Rathkopf DE, et al: Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med 371:424-433, 2014 Crossref, MedlineGoogle Scholar
18. Scher HI, Fizazi K, Saad F, et al: Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med 367:1187-1197, 2012 Crossref, MedlineGoogle Scholar
19. Shore ND, Chowdhury S, Villers A, et al: Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer (TERRAIN): A randomised, double-blind, phase 2 study. Lancet Oncol 17:153-163, 2016 Crossref, MedlineGoogle Scholar
20. Penson DF, Armstrong AJ, Concepcion R, et al: Enzalutamide versus bicalutamide in castration-resistant prostate cancer: The STRIVE trial. J Clin Oncol 34:2098-2106, 2016 LinkGoogle Scholar
21. Hussain M, Fizazi K, Saad F, et al: Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer. N Engl J Med 378:2465-2474, 2018 Crossref, MedlineGoogle Scholar
22. Tombal B, Borre M, Rathenborg P, et al: Long-term antitumor activity and safety of enzalutamide monotherapy in hormone naïve prostate cancer: 3-year open label followup results. J Urol 199:459-464, 2018 CrossrefGoogle Scholar
23. Tombal B, Borre M, Rathenborg P, et al: Enzalutamide monotherapy in hormone-naive prostate cancer: Primary analysis of an open-label, single-arm, phase 2 study. Lancet Oncol 15:592-600, 2014 Crossref, MedlineGoogle Scholar
24. Tombal B, Borre M, Rathenborg P, et al: Long-term efficacy and safety of enzalutamide monotherapy in hormone-naïve prostate cancer: 1- and 2-year open-label follow-up results. Eur Urol 68:787-794, 2015 CrossrefGoogle Scholar
25. Scher HI, Halabi S, Tannock I, et al: Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: Recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 26:1148-1159, 2008 LinkGoogle Scholar
26. Skaltsa K, Longworth L, Ivanescu C, et al: Mapping the FACT-P to the preference-based EQ-5D questionnaire in metastatic castration-resistant prostate cancer. Value Health 17:238-244, 2014 Crossref, MedlineGoogle Scholar
27. van Andel G, Bottomley A, Fosså SD, et al: An international field study of the EORTC QLQ-PR25: A questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer 44:2418-2424, 2008 Crossref, MedlineGoogle Scholar
28. Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 45:228-247, 2009 Crossref, MedlineGoogle Scholar
29. Braun DP, Gupta D, Staren ED: Predicting survival in prostate cancer: The role of quality of life assessment. Support Care Cancer 20:1267-1274, 2012 CrossrefGoogle Scholar
30. Tombal B, Saad F, Penson D, et al: Patient-reported outcomes following enzalutamide or placebo in men with non-metastatic castration-resistant prostate cancer (PROSPER): A multicentre, randomised, double-blind, phase 3 trial. Lancet Oncol 20:556-569, 2019 Google Scholar
31. Basch E: Patient-related outcomes for metastatic prostate cancer. Lancet Oncol 16:477-478, 2015 CrossrefGoogle Scholar
32. Endocyte announces FDA acceptance of radiographic progression free survival (rPFS) as an alternative primary endpoint of the VISION trial in addition to overall survival (OS). https://investor.endocyte.com/news-releases/news-release-details/endocyte-announces-fda-acceptance-radiographic-progression-free Google Scholar
33. Beaver JA, Kluetz PG, Pazdur R: Metastasis-free survival – A new end point in prostate cancer trials. N Engl J Med 378:2458-2460, 2018 Crossref, MedlineGoogle Scholar
34. Rathkopf DE, Beer TM, Loriot Y, et al: Radiographic progression-free survival as a clinically meaningful end point in metastatic castration-resistant prostate cancer: The PREVAIL randomized clinical trial. JAMA Oncol 4:694-701, 2018 Crossref, MedlineGoogle Scholar
35. Morris MJ, Molina A, Small EJ, et al: Radiographic progression-free survival as a response biomarker in metastatic castration-resistant prostate cancer: COU-AA-302 results. J Clin Oncol 33:1356-1363, 2015 LinkGoogle Scholar
36. Halabi S, Vogelzang NJ, Ou SS, et al: Progression-free survival as a predictor of overall survival in men with castrate-resistant prostate cancer. J Clin Oncol 27:2766-2771, 2009 LinkGoogle Scholar
37. ClinicalTrials.gov: Enzalutamide in first line androgen deprivation therapy for metastatic prostate cancer (ENZAMET). https://clinicaltrials.gov/ct2/show/NCT02446405?term=NCT02446405&rank=1 Google Scholar
38. Gravis G, Boher JM, Joly F, et al: Androgen deprivation therapy (ADT) plus docetaxel versus ADT alone in metastatic non castrate prostate cancer: Impact of metastatic burden and long-term survival analysis of the randomized phase 3 GETUG-AFU15 trial. Eur Urol 70:256-262, 2016 Crossref, MedlineGoogle Scholar
39. Kyriakopoulos CE, Chen YH, Carducci MA, et al: Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: Long-term survival analysis of the randomized phase III E3805 CHAARTED trial. J Clin Oncol 36:1080-1087, 2018 LinkGoogle Scholar

ARTICLE CITATION

DOI: 10.1200/JCO.19.00799 Journal of Clinical Oncology 37, no. 32 (November 10, 2019) 2974-2986.

Published online July 22, 2019.

PMID: 31329516

ASCO Career Center