Enzalutamide Added to ADT/Radiotherapy Fails to Improve Metastasis-Free Survival

The ENZARAD phase 3 trial randomized 802 men with high-risk localized or locally advanced prostate cancer to receive either enzalutamide or an older nonsteroidal antiandrogen alongside 24 months of ADT and definitive radiotherapy. After a median follow-up of 92 months, the trial reported no significant difference in 8-year metastasis-free survival (74% vs 72%, HR 0.88) or overall survival between arms, though a prespecified subgroup receiving planned pelvic nodal radiotherapy showed a possible benefit with enzalutamide (HR 0.47). Grade 3-5 adverse events occurred in 185 participants in each arm.

Most relevant for: Men with high-risk localized or locally advanced prostate cancer being considered for combined androgen deprivation therapy and radiotherapy, particularly those for whom pelvic nodal radiotherapy is planned.

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