Lawrence Karsh, MD, FACS, director, Clinical Research Department, The Urology Center of Colorado, discusses the TERRAIN trial, which compared enzalutamide with bicalutamide for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC).

The randomized TERRAIN trial, which enrolled 375 patients, compared the efficacy of the two single-agents, Karsh explains. In preclinical studies, enzalutamide demonstrated efficacy because it was tested against bicalutamide-resistant cells, he adds. The primary endpoint of the TERRAIN trial was progression-free survival (PFS), with secondary endpoints being change in prostate-specific antigen (PSA) and quality of life indicators.

PFS was 15.7 months in the enzalutamide arm versus 5.8 months in the bicalutamide arm. A higher PSA response was also found in the enzalutamide cohort compared with the bicalutamide cohort. Patients had longer time to deterioration when treated with enzalutamide compared with bicalutamide by approximately 5 months. In summary, Karsh says, enzalutamide has a higher efficacy rate than bicalutamide.

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Dr. Karsh on the TERRAIN Trial for Prostate Cancer

Lawrence Karsh, MD, director of the Clinical Research Department, at The Urology Center of Colorado, discusses strategies for sequencing the wide array of new agents available to treat men with castration-resistant prostate cancer.

Given the overall lack of data on sequencing, Karsh recommends utilizing practical considerations to determine how to best treat patients. These parameters include patient preference, comorbidities, and financial considerations. Furthermore, he notes, with the overall lack of available guidelines and biomarkers, most patients will likely receive several of the approved therapies.  

Lawrence Karsh, MD, from The Urology Center of Colorado, discusses strategies for sequencing treatments for men with metastatic castration-resistant prostate cancer.

Lawrence Karsh, MD

Articles

Dr. Karsh on the TERRAIN Trial for Prostate Cancer

Dr. Karsh Discusses Treatment Sequencing in mCRPC