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EMBARK Trial: Enzalutamide for nmCSPCa

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Posted 10/20/2023 2:43 PM (GMT 0)
https://www.nejm.org/doi/full/10.1056/nejmoa2303974?query=featured_home

Results from the EMBARK Trial published yesterday. 3 arms to the trial:
-- Combination, Lupron + Enzalutamide;
-- Lupron + placebo
-- Enzalutamide Monotherapy

The combination therapy was significantly superior to the other arms. The Enzalutamide Monotherapy was significantly superior to Lupron + placebo arm.

I wish the Enzalutamide Monotherapy arm had been nearly as effective as the combination therapy, maybe allowing patients to drop the Lupron. The other thing I didn't like is "intermittent" component for all arms. After 37 weeks the drug(s) were withdrawn when a patient's PSA became undetectable and then continued after the return of PSA.

In any case, the study confirms that Enzalutamide (Xtandi) is a great option for nmCSPCa after primary treatment failure. For those interested check out the Abstract or sift through the entire paper for some light reading. đŸ™‚

Edit
Crap, I guess it will only show the abstract, but it gives you the option of easily signing up for 2 free full length articles per month.
Posted 10/20/2023 5:32 PM (GMT 0)
Msttam, Great news as I am a relatively new X man, combined with 3 mo Lupron. Have had very good results. When I met with my MO in April to discuss systemic treatment, I asked his views about Zytiga viz XTANDI. He was very, very up about XTANDI, and alluded to findings in an as yet unpublished study in progress. He had the right information at the right time for me. So now the study is out. Thanks so much for posting. My three month check up is in two weeks. Certainly encouraged… Bill
Posted 10/20/2023 5:39 PM (GMT 0)
Just started Xandi while on lupron 3 weeks a go. PSA drop from 1.4 to .5 in first week. SE constipation and weakness so far. The second SE showed up while 30 miles from home diarrhea.

Post Edited (billyblob) : 10/23/2023 7:21:32 AM (GMT-8)

Posted 10/20/2023 6:27 PM (GMT 0)
@Newspaperlover. Xtandi seems to be building up a solid resume. I think there's every reason to believe it will do a great job for you.

@billyblob. Yeah, being on ADT isn't always fun. Hopefully some of the SE will lessen as you get used to the new normal.
Posted 10/20/2023 7:21 PM (GMT 0)
In 2019 I had to drop xtandi due to the side effects, but I continued with Lupron. Four years later I am still undetectable but have continued with Lupron. I give xtandi a lot of credit for where I am today.
Michael
Posted 10/21/2023 12:10 PM (GMT 0)
Xtandi + Eligard helped me kick the can down the road for 18 months before the side effects became debilitating. It dried up my mucous membranes - including tendon sheathes - such that I became unable to walk (inflamed Achilles tendons). Following the Xtandi websites advice I quit taking it immediately. In the 2 years since I have regained much of my ability to walk, though am only getting about 20 miles a week now rather than my previous 45 - 50 miles a week. I do not run as fast as I did either. Still improving however. smile

Gratefully, during that 18 months I went through an ORIOLE - type radiation treatment (spot to mets + interior pelvic lymph nodes area) and have had <0.1 (effective zeros) blood tests for 2 years now. Last 6 month Eligard expired Dec 20, none since June 20.
Posted 10/21/2023 4:00 PM (GMT 0)
Trailguy, Very difficult and troubling SE. Glad that you are feeling better and that PSA remains well contained… Bill
Posted 10/21/2023 8:45 PM (GMT 0)
Definitely a positive development. With respect to some earlier posts:
After five years, the combination (enzalutamide + leuprolide) was 87% effective and enzalutamide alone was 80% with overlapping confidence intervals.
Something to consider if one has to decide.

Another point to make is that there was no substantial between-group differences in quality-of-life measures.

Some further analysis:
https://www.urotoday.com/conference-highlights/esmo-2023/esmo-2023-prostate-cancer/147482-esmo-2023-enzalutamide-monotherapy-for-the-treatment-of-prostate-cancer-with-high-risk-biochemical-recurrence-embark-secondary-endpoints.html

Post Edited (Sr Sailor) : 10/21/2023 1:09:55 PM (GMT-8)

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