title: Phase Ib Study of Enzalutamide in Combination with Docetaxel in Men with Metastatic Castration-Resistant Prostate Cancer.
abstract: Preclinical evidence suggests that both docetaxel and enzalutamide target androgen receptor translocation and signaling. This phase Ib study assessed the safety, tolerability, and pharmacokinetics of docetaxel when administered with enzalutamide as first-line systemic chemotherapy in men with metastatic castration-resistant prostate cancer (mCRPC).
  
  
  
  Docetaxel-naïve patients received 21-day cycles of docetaxel (75 mg/m(2)). Enzalutamide (160 mg/day) was administered daily starting on day 2 of cycle 1. Patients were allowed to stop and restart docetaxel at any time following cycle 2. Treatment continued indefinitely until unacceptable toxicity or discontinuation due to investigator or patient preference.
  
  
  
  A total of 22 patients received docetaxel, of whom 21 also received enzalutamide. Docetaxel was administered for a median of 5.0 cycles and enzalutamide for a median of 12.0 months. With concomitant treatment, geometric mean docetaxel exposure decreased by 11.8%, whereas peak concentrations decreased by 3.7% relative to docetaxel alone. The most common toxicities observed during the period of concomitant therapy were neutropenia (86.4%) and fatigue (77.3%). Common toxicities observed with post-docetaxel enzalutamide were constipation (23.8%), decreased appetite (19.0%), fatigue (19.0%), and musculoskeletal pain (19.0%). Treatment with enzalutamide and docetaxel resulted in prostate-specific antigen decreases in almost all patients based on exploratory analysis of available baseline and on-study prostate-specific antigen data.
  
  
  
  The combination of docetaxel and enzalutamide is feasible, although higher rates of neutropenia and neutropenic fever than anticipated were observed. Reductions in docetaxel exposure with enzalutamide coadministration were not considered clinically meaningful. This combination warrants further study in a larger mCRPC population. Clin Cancer Res; 22(15); 3774-81. ©2016 AACR.
authors: Memorial Sloan Kettering Cancer Center, New York, New York. morrism@mskcc.org.
authors: Michael J
authors: MJ
authors: Morris
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Dana E
authors: DE
authors: Rathkopf
authors: Medivation, Inc., San Francisco, California.
authors: William
authors: W
authors: Novotny
authors: Medivation, Inc., San Francisco, California.
authors: Jacqueline A
authors: JA
authors: Gibbons
authors: Medivation, Inc., San Francisco, California.
authors: Amy C
authors: AC
authors: Peterson
authors: Medivation, Inc., San Francisco, California.
authors: Zakaria
authors: Z
authors: Khondker
authors: Astellas Pharma Global Development, Inc., Northbrook, Illinois.
authors: Taoufik
authors: T
authors: Ouatas
authors: Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Howard I
authors: HI
authors: Scher
authors: Virginia Oncology Associates, Norfolk, Virginia.
authors: Mark T
authors: MT
authors: Fleming
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001549:Benzamides; D003131:Combined Modality Therapy; D000077143:Docetaxel; D016903:Drug Monitoring; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009570:Nitriles; D010669:Phenylthiohydantoin / Q000008:administration & dosage / Q000031:analogs & derivatives; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D019233:Retreatment; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D009570:Nitriles; D043823:Taxoids; D000077143:Docetaxel; D010669:Phenylthiohydantoin; C540278:enzalutamide