Silke Gillessen presented the early results of PEACE3 at ESMO 2024. Compared to Xtandi alone, Xofigo+Xtandi:
• improved radiographic progression-free survival by 31%
• improved overall survival by 31%
These were men who had predominantly bone metastases and all received a bone strengthening agent (Zometa or Xgeva). They may have received Zytiga previously.
Unfortunately not the case for my Father, but mu goodness I hope it has helped so many others .
That will be me someday. Thanks for the info! Do you have a link?
Does that help to break hormone resistance ? I mean if I am planing to do Xofigo and Xtandi did not work in past in that case I can start Xtandi and start xofigo together and may see similar results base on clinical data ?
Probably not. This trial, at the basis, is about treating men with bone mets, hence the xofigo + Xtandi vs Xtandi alone. You'll need to consider BAT to to break hormone resistanc.
BAT does not break hormone resistance. It may, in some cases, keep Xtandi working longer when it is given for mCRPC.
No. There is no known way to reverse castration resistance. I doubt it will work if Xofigo and Xtandi have already failed.
This describes my husband's treatment regimen in the spring of '23. But Xtandi had already failed - still I wonder if continuing to take it while getting Xofigo is the reason his PSA remained somewhat stable during those months - not an expected result from Xofigo.
Based on PSMA I have a met on a rib bone and another spot. I have had spot radiation but I know the end is coming.
They accepted asymptomatic patients for the trial.
Yes, for all of us, PCa or not. I will note that there have bbeen numerous men here in your situation who have had very good prolongation of life with additional treatment.......perhaps you have already exhausted the options?
brilliant summary sir. Thank you
Thanks for sharing 👍👍👍
Is there also a similar trial with Xofigo + Zytiga?
The combination of Zytiga and Xofigo was tried in the ERA 223 trial. The trial was stopped early because there were about 3 times more fractures in the group receiving the combination than in the group receiving a placebo and Zytiga. The combination now carries a black-box warning against the combined use.
It appears that the problem may is resolved by using a bone-strengthening agent (like Xgeva or Zometa). When they looked at the subgroup who had taken bone-strengthening agents, 15% of those taking Xofigo+Zytiga vs 7% of those taking Zytiga-only experienced a fracture.
Dropping from 3X down to 2X doesn't make me feel too warm and fuzzy. Also, since I've now exhausted my Xgeva treatment and only have one more Zometa infusion planned, it looks like I might need to consider switching over to Xtandi from my 5 year run of Zytiga(if that's even a viable option)
As you know, I'm not a fan of youtube videos or podcasts. Even her presentation at ESMO is not ideal, although some conferences include a peer response. There's no need for a podcast among people not involved in the trial. It will be published in a peer-reviewed journal soon.
Oh. Not published so we cannot review the study design, criteria, populations etc at this time? No way to evaluate what 31’% RPFS an 13% OS actually mean. Over what time period? Just the mean or more robust breakdown of distribution. I am skeptical of these limited conclusions That sound so conclusive. I expect you to be the advocate for careful analysis.
Here's more details:
onclive.com/view/addition-o...
Details of the study design, criteria, populations, etc. are all given in the clinical trial design. This was a closely anticipated trial that came about after the problem of bone events stopped the trial of Xofigo+Zytiga. This trial was reviewed for interim results. The mortality of the control group was 80% so I don't expect it will change much upon publication.
Thanks Allen. That is the info I wanted to review about it.
Thanks Daryll. YouTube videos are just as good as non peer reviewed commentary websites. The reader or watcher can do their own home work.
BTW. The 2024 WSC will be 2 hours South on I-95 this year. Go Phillies!!!!
It’s a hot button topic. One I normally coward in the corner from and hope everything turns out ok.
My wife became a different person a few years ago. I was often gone on work trips.
She fell deep into the rabbit hole algorithms of youtube.
She’s an intelligent person too.
It’s been said often but peer review is so important.
Unfortunately the New England Journal etc. doesn’t have enticing video’s for the average person and thus one of many draws to youtube.
What I posted isn't a video. It's a ten minute audio recap for lay people about today's prostate cancer relevant presentations at ESMO.
One of my problems with both youtube videos and podcasts is that I read so much faster than I can listen, even at 1.75X speed, which is about as fast as it can be to still be intelligible. Also, one K-M curve is worth a thousand words. For example, this transcript of an interview with Oliver Sartor about the SPLASH trial:
urotoday.com/video-lectures...
This has all the charts that nerds like me could want:
urotoday.com/conference-hig...
And this is a peer review:
urotoday.com/conference-hig...
Wow yes. I'll have to try youtube videos at increased playback. Never thought of that but I doubt I'll be able to handle 1.75 lol.
Not to brag or I guess actually to brag ha. I have found myself at UroToday often over these last years.
Grateful for your nerdiness btw lol.
Hi Tall Allen,
Will the combination of Xtandi and Xofigo be effective now that Xtandi alone is no longer effective to me? Does Xofigo best go with Xtandi but not with other anti-androgen drugs?
Thanks.
That trial was among men who were Xtandi-naive. You may want to discuss using a different anti-androgen (i.e., apalutamide or darolutamide). Or, docetaxel has been shown to reverse enzalutamide resistance:
prostatecancer.news/2022/10...
And, the combination of Xofigo and docetaxel may work better than docetaxel alone, even with a reduced dose of docetaxel:
ejcancer.com/article/S0959-...
IMO, this would be a good time to add Provenge too:
Radium-223 + Xtandi?
Zytiga after Xtandi? 
Xtandi not working?
Xtandi & PSA
Xtandi for PSMA expression
