(Prostate Cancer) Xtandi + Zytiga + Prednisone Effective?
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This article is a summary of international medical information and is not medical advice; it cannot replace the diagnosis or treatment plan of your attending physician. The medical technologies, drug information and clinical data presented here are compiled from public literature and official statements of major Japanese medical institutions; the applicability and outcome of any therapy vary with each patient and must be assessed individually by a qualified physician.
On March 30, 2023, Michael J. Morris et al. from Memorial Sloan Kettering Cancer Center published in the medical journal Journal of Clinical Oncology the efficacy and safety results of Xtandi (enzalutamide) monotherapy versus Xtandi + Zytiga (abiraterone acetate) + prednisone combination therapy in patients with metastatic castration-resistant prostate cancer in the Alliance A031201 Phase III clinical trial.
The Alliance A031201 Phase III trial randomized patients with metastatic castration-resistant prostate cancer (N=1,311) in a 1:1 ratio into the Xtandi group (160 mg once daily; N=657) and the Xtandi (160 mg once daily) + Zytiga (1,000 mg once daily) + prednisone (5 mg twice daily) group (N=657). The primary endpoint was overall survival (OS); other endpoints included safety and radiographic progression-free survival.
Results: The primary endpoint median OS was: Xtandi group 32.7 months vs. Xtandi + Zytiga + prednisone group 34.2 months — no significant difference between the two groups. Radiographic PFS was: Xtandi group 21.3 months vs. Xtandi + Zytiga + prednisone group 24.3 months.
On the other hand, regarding safety, the drug metabolism rate in the Xtandi + Zytiga + prednisone group was 2.2–2.9 times higher than in the Xtandi group.
Based on Alliance A031201 results, Michael J. Morris concluded: In metastatic castration-resistant prostate cancer, there was no significant improvement between Xtandi monotherapy and Xtandi + Zytiga + prednisone. The increased metabolism of Zytiga may be related to interactions with Xtandi and prednisone, and this phenomenon cannot currently be prevented.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.22.02394
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