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Cattrini C, Caffo O, De Giorgi U, Mennitto A, Gennari A, Olmos D, Castro E. Apalutamide, Darolutamide and Enzalutamide for Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC): A Critical Review. Cancers (Basel) 2022; 14:1792. [PMID: 35406564 PMCID: PMC8997634 DOI: 10.3390/cancers14071792] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
Nonmetastatic castration-resistant prostate cancer (nmCRPC) represents a condition in which patients with prostate cancer show biochemical progression during treatment with androgen-deprivation therapy (ADT) without signs of radiographic progression according to conventional imaging. The SPARTAN, ARAMIS and PROSPER trials showed that apalutamide, darolutamide and enzalutamide, respectively, prolong metastasis-free survival (MFS) and overall survival (OS) of nmCRPC patients with a short PSA doubling time, and these antiandrogens have been recently introduced in clinical practice as a new standard of care. No direct comparison of these three agents has been conducted to support treatment choice. In addition, a significant proportion of nmCRPC on conventional imaging is classified as metastatic with new imaging modalities such as the prostate-specific membrane antigen positron emission tomography (PSMA-PET). Some experts posit that these "new metastatic" patients should be treated as mCRPC, resizing the impact of nmCRPC trials, whereas other authors suggest that they should be treated as nmCRPC patients, based on the design of pivotal trials. This review discusses the most convincing evidence regarding the use of novel antiandrogens in patients with nmCRPC and the implications of novel imaging techniques for treatment selection.
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Affiliation(s)
- Carlo Cattrini
- Department of Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Medical Oncology, Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy;
| | - Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Alessia Mennitto
- Department of Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Medical Oncology, Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
| | - Alessandra Gennari
- Department of Medical Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (C.C.); (A.M.); (A.G.)
- Medical Oncology, Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), 28100 Novara, Italy
| | - David Olmos
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain;
| | - Elena Castro
- Genitourinary Cancer Translational Research Group, Instituto de Investigación Biomédica de Málaga, 29010 Málaga, Spain
- UGCI Medical Oncology, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, 29010 Málaga, Spain
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Abstract
Oral enzalutamide (Xtandi®), a second generation androgen receptor inhibitor, is indicated for the treatment of castration-resistant prostate cancer (CRPC) in numerous countries worldwide, with specific indications in this patient population varying between individual countries. Based on extensive experience in the clinical trial and/or real-world settings, oral enzalutamide 160 mg once daily is an effective and generally well tolerated treatment in a broad spectrum of patients with CRPC, including in nonmetastatic and metastatic disease and in chemotherapy-naive and -experienced metastatic CRPC. Enzalutamide is an emerging option for the treatment of men with nonmetastatic CRPC who are at high-risk for developing metastatic disease, and remains an important first-line option in chemotherapy-naive or -experienced patients with metastatic CRPC.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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