ENZAMET.

Rationale: Out of all the treatment options for metastatic castrate-sensitive prostate cancer (mCSPC), enzalutamide ain’t one of ‘em. In the setting of an ever-tightening market for castrate-resistant disease, the Astellas-funded ENZAMET trial is based on the market-expanding hypothesis that early use of enzalutamide for treatment-naive mCSPC will improve survival over—and this is key—other “conventional” androgen receptor (AR)-blockers such as bicalutamide when either is used in combo with ADT. This is to say, there was no standard use of what is currently considered first-line: docetaxel or abiraterone.
Betting Line: Enzalutamide in place of a first-generation AR-blocker in combo with ADT will prolong survival as first-line treatment for mCSPC, ultimately serving only to further confuse physicians on the best go-to systemic therapy. | Sweeney, ASCO Plenary 2019