Physician Views: A first glimpse at Xtandi and apalutamide in non-metastatic prostate cancer

Later this week at the ASCO Genitourinary Cancers Symposium, Pfizer/Astellas and Johnson & Johnson will present Phase III data for Xtandi and apalutamide, respectively, for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC). Ahead of the conference we are snap-polling oncologists and urologists in the US and EU5 markets to gauge assessment of top-line data, which were released in abstracts on Monday.

New Phase III data show that Xtandi (enzalutamide), in combination with androgen deprivation therapy (ADT), cut the risk of metastasis or death by a significant 71 percent in patients with non-metastatic castration-resistant prostate cancer (nmCRPC), versus ADT alone. Median metastasis-free survival (MFS) was 36.6 months for the Xtandi arm versus 14.7 months for ADT alone. 

Separate Phase III data show that the orally administered, next-generation androgen receptor inhibitor apalutamide significantly decreased the risk of distant metastasis or death by 72 percent versus placebo in nmCRPC patients, with a median MFS of 40.5 months versus 16.2 months.

Taking into account the primary endpoint of MFS and exposure of nmCRPC patients to additional toxicity, do you consider these (top-line) data as likely practice changing?


Yes - in patients with rising prostate-specific antigen (PSA) levels


Are you comfortable with these drugs being approved to treat nmCRPC based on a primary endpoint of MFS?

Yes - and would have no impact on my utilisation

Yes - but would have slightly negative impact on my utilisation

Yes - but would have moderately negative impact on my utilisation

Yes - but would have significantly negative impact on my utilisation

No - need overall survival data

How would you best describe the size of the patient cohort (patients with nmCRPC) eligible to receive these treatments in this indication?

Very small




Very large

Will prior physician experience with Xtandi provide it a meaningful commercial advantage over apalutamide if the totality of data indicates broadly comparative clinical profiles for these two agents?



Would near-term availability of generic Zytiga (abiraterone) limit adoption of Xtandi and/or apalutamide in nmCRPC?


Yes - slightly

Yes - moderately

Yes - significantly

Yes - very significantly

Results and related analysis will shortly be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

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