Enzalutamide as a Fourth- or Fifth-Line Treatment Option for Metastatic Castration-Resistant Prostate Cancer

Sushil K. Badrising, Vincent van der Noort, Paul Hamberg, Jules L. L. M. Coenen, Maureen J. Aarts, Inge M. van Oort, Alfons J. M. van den Eertwegh, Maartje Los, H. Pieter van den Berg, Hans Gelderblom, Suzan Vrijaldenhoven, Emile D. Kerver, Theo van Voorthuizen, Igle J. de Jong, John B. Haanen, Andries M. Bergman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Web of Science)


Objective: To evaluate the efficacy of enzalutamide (Enz) as fourth- or fifth-line treatment in men with metastasized castration-resistant prostate cancer (mCRPC), by analyzing a retrospective cohort of heavily pretreated patients.
Methods: We evaluated toxicity, overall survival (OS), progression-free survival (PFS) and time to prostate-specific antigen (PSA) progression data from 47 CRPC patients treated with fourth- or fifth-line Enz.
Results: All patients were treated with docetaxel and abiraterone acetate and 42 patients (89%) with cabazitaxel. The median age of the patients was 69 years (IQR, 63-73.5), 79% had bone metastases, 55% had lymph node metastases, and 17% had visceral metastases. The median duration of Enz treatment was 12.0 weeks (IQR, 8.3-20.4), and 11 patients (23%) responded to Enz (maximum PSA decline ≥50%). In general, Enz was well tolerated, with the most frequently reported adverse events being fatigue and nausea. The median OS was 40.1 weeks (95% CI, 25.4-61.4), the median PFS was 12.1 weeks (95% CI, 9.9-14.0) and the median time to PSA progression was 15.7 weeks (95% CI, 14.0-28.7).
Conclusions: Analysis of this retrospective cohort suggests that Enz is well tolerated and that there is a 23% response rate in heavily pretreated CRPC patients, which is comparable with third-line treatment outcomes.
Original languageEnglish
Pages (from-to)267-273
Number of pages7
Issue number5
Publication statusPublished - 2016


  • Cross-resistance
  • Treatment sequence
  • Heavily pretreated patients
  • Time interval
  • Docetaxel
  • Abiraterone
  • Cabazitaxel
  • Radium-223

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