Should Enzalutamide and Abiraterone Be Combined in Conjunction With Long-Term Androgen-Deprivation Therapy?

By: Jenna Carter, PhD
Posted: Wednesday, July 5, 2023

An article published in The Lancet Oncology reported on whether the long-term outcomes of combining enzalutamide plus abiraterone with androgen-deprivation therapy improved survival in patients with metastatic prostate cancer. Gerhardt Attard, PhD, of the Cancer Institute, University College London, and colleagues found that based on the final results of two randomized phase III trials of the STAMPEDE platform protocol, enzalutamide and abiraterone should not be combined for those starting long-term androgen-deprivation therapy. “Clinically important improvements in survival from [the] addition of abiraterone to androgen-deprivation therapy are maintained for longer than 7 years,” they added.

The first trial (abiraterone trial) consisted of a total of 1,003 patients with metastatic prostate cancer, in which patients were randomly assigned to the standard of care (n = 502) or the standard of care plus abiraterone (n = 501). The second trial (abiraterone-and-enzalutamide trial) had a total of 916 patients assigned to either the standard of care (n = 454) or the standard of care plus abiraterone and enzalutamide (n = 462). The standard of care included androgen-deprivation therapy.

Findings revealed that in the abiraterone trial, the median overall survival was 76.6 months (95% confidence interval [CI] = 67.8–86.9 months) with abiraterone versus 45.7 months (41.6 months–52.0 months) with the standard of care (hazard ratio [HR] = 0.62; 95% CI = 0.53–0.73]; P < . 0001). In the abiraterone-plus-enzalutamide trial, the median overall survival was 73.1 months (61.9–81.3 months) with abiraterone plus enzalutamide versus 51.8 months (45.3–59.0 months) the standard of care alone (HR = 0.65 [0.55–0.77]; P < .0001).

“Given the similar efficacy reported when combining enzalutamide with androgen-deprivation therapy, we also conclude that combining abiraterone with enzalutamide would not be more effective,” the study authors stated.

Disclosure: For full disclosures of the study authors, visit thelancet.com.

Lancet Oncology