ENZAMET.

Headline: The addition of enzalutamide to ADT for metastatic castrate-sensitive prostate cancer (mCSPC) prolongs survival over other first-generation androgen receptor (AR)-blockers. The ENZAMET trial randomized over 1100 men with mCSPC on ADT to a first-gen AR-blocker (e.g.,  bicalutamide, nilutamide, or flutamide) versus the newer AR-blocker enzalutamide. Since docetaxel was coming on the scene, it was allowed in a non-randomized fashion per physician preference. As predicted, overall survival at 3 years was significantly prolonged in the enzalutamide arm from 72 → 79%, which held true across low and high-volume disease. On the other hand, there was no benefit with enzalutamide among those receiving early docetaxel.
TBL: If you weren’t confused enough on which systemic therapy to offer first for mCSPC, you can now add enzalutamide to the mix. | Davis, N Engl J Med 2019