Non-inferior survival and enhanced longevity with initial low-dose versus full-dose enzalutamide: a single-centre real-world prostate cancer study
- 1Cancer Tech Care
Abstract
BackgroundProstate cancer enzalutamide treatment is approved at a standard dose of 160 mg daily. Concerns for real-world patients -- older and more fragile than those enrolled in clinical trials -- have prompted consideration of initiating treatment with lower doses, but the long-term efficacy of this approach remains unknown. We evaluate the long-term survival and longevity in patients treated with standard versus upfront low-dose enzalutamide.
MethodsRetrospective analysis of 151 patients treated with enzalutamide (102 receiving 160 mg; 49 receiving [≤]80 mg) between 2014-2021 at the Centre Hospitalier Universitaire de Martinique, with complete follow-up through end of life (98.7% completeness of follow-up). Primary outcomes were overall survival (OS), progression-free survival (PFS), and longevity (attained age).
ResultsDoses [≤]80 mg were associated with longer median OS (36.3 vs. 20.7 months), improved restricted mean OS (difference of 0.7 years, p=0.05), and enhanced longevity (median 82.5 vs. 78.3 years, p=0.004). PSA response rate at 12 weeks was higher with lower-dose (71.4% vs. 48.8%, p=0.016). In multivariable models adjusted for prognostic factors, [≤]40 mg compared with 160 mg was non-inferior regarding OS (HR=0.61, 95% CI 0.36-1.06), superior regarding PFS (HR=0.59, 95% CI 0.35-0.99), and superior regarding longevity (HR=0.48, 95% CI 0.28- 0.84). Bone metastasis, poor performance status, PSA response, time to PSA nadir, and disease duration were independent predictors of outcomes. A post-hoc analysis revealed a strong association between dose and physician-prescribing profiles, ranging from "endorse-lowest-dose" to "never-deviate-from-full-dose".
ConclusionsLower doses of enzalutamide were non-inferior to full-dose. Dose-adapted strategies warrant further investigation.
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BibTeX
@misc{gorobets2026noninferior,
title = {{Non-inferior survival and enhanced longevity with initial low-dose versus full-dose enzalutamide: a single-centre real-world prostate cancer study}},
author = {O. Gorobets and V. Vinh-Hung},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.28.26361616},
url = {https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Non-inferior survival and enhanced longevity with initial low-dose versus full-dose enzalutamide: a single-centre real-world prostate cancer study
AU - O. Gorobets
AU - V. Vinh-Hung
PY - 2026
DA - 2026/08/28
PB - medRxiv
DO - 10.64898/2026.08.28.26361616
UR - https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1
AB - BackgroundProstate cancer enzalutamide treatment is approved at a standard dose of 160 mg daily. Concerns for real-world patients -- older and more fragile than those enrolled in clinical trials -- have prompted consideration of initiating treatment with lower doses, but the long-term efficacy of this approach remains unknown. We evaluate the long-term survival and longevity in patients treated with standard versus upfront low-dose enzalutamide. MethodsRetrospective analysis of 151 patients treated with enzalutamide (102 receiving 160 mg; 49 receiving [≤]80 mg) between 2014-2021 at the Centre Hospitalier Universitaire de Martinique, with complete follow-up through end of life (98.7% completeness of follow-up). Primary outcomes were overall survival (OS), progression-free survival (PFS), and longevity (attained age). ResultsDoses [≤]80 mg were associated with longer median OS (36.3 vs. 20.7 months), improved restricted mean OS (difference of 0.7 years, p=0.05), and enhanced longevity (median 82.5 vs. 78.3 years, p=0.004). PSA response rate at 12 weeks was higher with lower-dose (71.4% vs. 48.8%, p=0.016). In multivariable models adjusted for prognostic factors, [≤]40 mg compared with 160 mg was non-inferior regarding OS (HR=0.61, 95% CI 0.36-1.06), superior regarding PFS (HR=0.59, 95% CI 0.35-0.99), and superior regarding longevity (HR=0.48, 95% CI 0.28- 0.84). Bone metastasis, poor performance status, PSA response, time to PSA nadir, and disease duration were independent predictors of outcomes. A post-hoc analysis revealed a strong association between dose and physician-prescribing profiles, ranging from "endorse-lowest-dose" to "never-deviate-from-full-dose". ConclusionsLower doses of enzalutamide were non-inferior to full-dose. Dose-adapted strategies warrant further investigation.
ER -