STAMPEDE: abiraterone with or without enzalutamide added to androgen deprivation for high-risk non-metastatic prostate cancer
Adding two years of abiraterone to hormone therapy and radiotherapy for high-risk localised or node-positive prostate cancer halved the risk of metastases and cut deaths by 40 percent, while adding enzalutamide on top brought only extra toxicity.
Overview
Meta-analysis of two STAMPEDE comparisons including 1,974 men with high-risk non-metastatic prostate cancer (node-positive, or node-negative with at least two of T3/4, Gleason 8 to 10, PSA 40 or more) randomised to androgen deprivation with or without two years of abiraterone (with enzalutamide in the second comparison).
Six-year metastasis-free survival was 82 versus 69 percent (hazard ratio 0.53) and overall survival 86 versus 77 percent (hazard ratio 0.60); enzalutamide added toxicity without efficacy.
- Six-year metastasis-free survival 82 percent vs 69 percent; hazard ratio 0.53.
- Six-year overall survival 86 percent vs 77 percent; hazard ratio 0.60.
Two years of abiraterone with androgen deprivation and radiotherapy is the standard for very high-risk and node-positive localised prostate cancer.
- Most men received radiotherapy; benefit after prostatectomy is less certain.
- Staging was by conventional imaging.
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