Patients with metastatic castration - resistant prostate cancer (CRPC) had higher prostate - specific antigen (PSA) response when treated
with enzalutamide compared with abiraterone / prednisone, but had no difference in time to progression or time to PSA progression, according to the results of a study (abstract 5002) presented by Kim N. Chi, MD, of the British Columbia Cancer Agency in Vancouver, at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2 — 6.
At this point, 72 percent
of enzalutamide patients and 63 percent of placebo patients were alive at the trial cutoff date showing a 29 percent overall improvement in survival.
A PSA decline rate of 50 % or greater was seen in 77 % of patients
assigned enzalutamide compared with 55 % of patients assigned abiraterone / prednisone (P =.0012).
Similarly, the time to unconfirmed PSA progression was 8.0 months for
enzalutamide compared with 7.4 months for abiraterone (HR, 0.83; 95 % CI, 0.59 — 1.17; P =.283).
Associate professor Mary - Ellen Taplin, of the Dana - Farber Cancer Institute, Boston, USA, will tell the 26th EORTC - NCI - AACR Symposium on Molecular Targets and Cancer Therapeutics in Barcelona, Spain, that galeterone was well tolerated by patients in the ARMOR2 trial, and also lowered PSA levels in a subset of men with CRPC that was resistant to other drugs that target the cancer, such
as enzalutamide and abiraterone.
The goal of the current study was to explore the bioavailability and safety of the anti-androgen
agent enzalutamide alone and in combination with the existing agent fulvestrant (FDA approved for use in metastatic hormone - receptor positive breast cancer).
The time to confirmed PSA progression was 14.9 months
for enzalutamide and 10.2 months for abiraterone / prednisone (hazard ratio [HR], 0.83; 95 % CI, 0.55 — 1.25; P =.372).
Leigh Ellis, PhD, and colleagues at Roswell Park Comprehensive Cancer Center (Roswell Park) have identified two genes that appear to be simultaneously overexpressed in aggressive prostate cancers resistant to the androgen - targeted
treatments enzalutamide and abiraterone acetate.
Enzalutamide targets a pathway inside prostate cancer cells that was discovered as a result of over a decade of painstaking laboratory and clinical science.
Enzalutamide works differently than other hormone therapies; rather than reducing hormone levels, it blocks hormone binding to the androgen receptor — an essential step in hormone action.
The strong response to this new use of
enzalutamide shows that it can provide a viable, less toxic alternative to chemotherapy in staving off the disease in men who aren't responding to standard first line hormonal treatments,» said Tomasz Beer, M.D., the lead author on the study and deputy director of the Knight Cancer Institute at OHSU.
The scientists say these results suggest that testosterone therapy has the potential to reverse the resistance that eventually develops to testosterone - blocking drugs
like enzalutamide.
The double blind Phase III study included 1,717 research participants enrolled at 207 sites globally between September 2010 and September 2012; 872
received enzalutamide while the others received a placebo.
A comprehensive analysis of the study's results — published in June 1 online edition of the New England Journal of Medicine and to be presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago — found participants treated with
enzalutamide saw an 81 percent reduction in the risk the cancer would progress and a 29 percent reduction in the risk of death.
The small, phase 1 trial enrolled 11 patients and found that side - effects were similar in this population as previously reported in larger trials of
enzalutamide against prostate cancer.
This 41 percent PSA response rate to taxane therapy is notable because the PSA response rate to abiraterone or
enzalutamide in AR - V7 - positive patients was 0 percent in the authors» prior study.
With
enzalutamide there were more patients with grade 2 fatigue and one patient with seizure.
A new study found that patients with mCRPC had higher PSA response with
enzalutamide vs abiraterone, but no difference in time to progression, and reported worse outcomes in those with quantifiable ctDNA.
At that point, physicians switch to other drugs, such
as enzalutamide, which block testosterone's ability to bind to receptors within prostate cancer cells.
Results of a multicenter phase 1 clinical trial presented today at the 2015 San Antonio Breast Cancer Symposium show that the anti-androgen
agent enzalutamide is active and well - tolerated alone and with fulvestrant in patients with advanced breast cancer.
Interestingly, the
drug enzalutamide is in wide use for prostate cancer, which tends to be driven by and dependent on androgen receptor.
«Phase 1 results point to larger trial
of enzalutamide and fulvestrant in breast cancer.»
«Recent data have shown that a variant of the androgen receptor called AR - V7, found in tumour cells circulating in the blood of patients with metastatic CRPC, predicted resistance to treatment
with enzalutamide and abiraterone,» she will say.
Among patients who were resistant to
enzalutamide, nine were evaluable; five out of nine (56 %) had any PSA decline.
Several clinical centres in the USA and Canada recruited four groups of men with CRPC to a phase II study to receive 2550 mg of galeterone orally once a day: 22 men had CRPC that had not metastasised (spread) and had received no previous treatment; 39 men had metastatic CRPC and no previous treatment with abiraterone or
enzalutamide; 37 and nine men had metastatic CRPC and had failed treatment with abiraterone and enzalutamide respectively.
Among the group of men who had non-metastatic and metastatic disease who had not received prior treatment with abiraterone and
enzalutamide, data for 60 were available for analysis.
Galeterone will now be tested in a phase III trial in which patients with metastatic CRPC with the AR - V7 variant will be randomised to receive either galeterone or
enzalutamide.
This suggests that the presence of AR - V7 in circulating tumour cells does not preclude response to galeterone as has been shown to be the case for abiraterone and
enzalutamide.»
Enzalutamide, which is taken as four pills once per day, is already approved by the Food and Drug Administration (FDA) for men whose disease has not been stopped by other treatments including, surgery, radiation, androgen deprivation therapy and chemotherapy.
While the outlook of patients with this gene variant is poor, these studies offer hope for a new treatment strategy for these men, and more studies are needed using next - generation androgen inhibitors, such as abiraterone and
enzalutamide.
Enzalutamide is also being evaluated in a phase 2 clinical trial in combination with the aromatase inhibitor exemestane (NCT02007512) and demonstrated promising results in another phase 2 trial against estrogen - receptor - negative advanced disease (NCT01889238).
«These data support moving forward with a larger trial of
the enzalutamide plus fulvestrant combination.»
To find out, Barton and colleagues treated cell lines with the drug
enzalutamide and with shRNAs designed to knock down androgen receptor levels.
Subjects must have progressed on prior new hormonal agent (e.g. abiraterone acetate and / or
enzalutamide) for the treatment of mCRPC.
Professor de Bono has led ground - breaking clinical trials testing new treatments for men with this disease, for example abiraterone, cabazitaxel and
enzalutamide.
A Phase III, Open Label, Randomized Study to Assess the Efficacy and Safety of Olaparib (Lynparza) versus
Enzalutamide or Abiraterone Acetate in Men with Metastatic Castration - Resistant Prostate Cancer who have Failed Prior Treatment with a New Hormonal Agent and have Homologous Recombination Repair Gene Mutations.
This phase II study included 202 treatment - naive patients and randomly assigned them to abiraterone or
enzalutamide with crossover at PSA progression.
Inhibition of cell migration and invasion of
enzalutamide - resistant prostate cancer cells was effected by niclosamide through its effects on the androgen receptor (AR)- STAT3 signaling axis [40].
Abiraterone / prednisone and
enzalutamide are both first - line therapies for treatment of metastatic CRPC but no trials to date have compared them head to head.
In addition, 20 % of patients assigned abiraterone had a rising PSA as best response compared with 10 % of patients assigned
enzalutamide (P =.0501).
Patient 2 was diagnosed with widespread metastatic prostate cancer in 2013 and progressed on numerous systemic therapies, including leuprolide, bicalutamide,
enzalutamide, abiraterone, and eventually docetaxel.
He has played a key role in the discovery and development of multiple approved drugs, including imatinib (Gleevec), dasatinib (Sprycel), and
enzalutamide (Xtandi).