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• W2327851057 abstract "death. 11 To illustrate the natural history of prostate cancer relative to various treatments and to assess the response status to different therapies (ie,antiandrogens), a conceptual description of the natural history of prostate cancer referred to as the states model has been proposed (Fig 1). In this model, the history of a patient's prostate cancer is described as progression through a series of states from diagnosis to death. Each state represents a clinically significant category, and progression from one statetoanother reflects a change in prognosis generally prompting a change in therapy. 12 In the article accompanying this editorial, Penson et al 13 present results of the STRIVE (Safety and Efficacy Study of Enzalutamide Versus Bicalutamide in Men With Prostate Cancer) trial, a study in chemotherapy-na¨ive men with metastatic CRPC or nonmetastatic CRPC comparing progression-free survival (PFS) with enzalutamide 160 mg/d versus bicalutamide 50 mg/d administered as secondary hormonal therapy. Data from this trial clearly validate the preclinical studies noted earlier that demonstrate the superiority of enzalutamide over bicalutamide as an antiandrogen. With respect to the primary end point, enzalutamide, when compared with bicalu- tamide, reduced the risk of death or progression, which was defined as prostate-specific antigen (PSA) progression or investigator assessed radiographic progression by 76% (HR, 0.24; 95% CI, 0.18 to 0.32). In addition, the secondary end points of PSA progression, proportion of patients with a significant (. 50%) PSA decrease, and radiographic PFS, strongly favored enzalutamide. In the 139 patients with non- metastatic CRPC, the median radiographic PFS was not yet reached in either arm. However, enzalutamide reduced risk of radiographic progression by 76% (HR,0.24; 95% CI, 0.10to0.56) comparedwith bicalutamide. In the 257 patients with metastatic CRPC, enzalu- tamidereducedtheriskofradiographicprogressionby68%.Median radiographic PFS was not reached with enzalutamide and was 8.3 months with bicalutamide (HR, 0.32; 95% CI, 0.21 to 0.50; P,.001). One should consider the 50 mg/d bicalutamide dosing that was chosen for the study when interpreting these findings. Bicalu- tamide has been FDA-approved for men with nonmetastatic CRPC at this dose and when used conjunction with androgen deprivation therapy (ADT). 14 It is possible that bicalutamide 50 mg/d may be insufficient to block the AR amplification observed in CRPC, and a higher dose of 150 mg/d may have resulted in improved efficacy of the bicalutamide control arm. These results are compelling, but how can these data be used in clinical practice and how might these results influence the future" @default.
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• W2327851057 date "2016-06-20" @default.
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• W2327851057 title "Striving Toward a Cure for Prostate Cancer" @default.
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• W2327851057 doi "https://doi.org/10.1200/jco.2015.66.3146" @default.
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