The EMBARK trial recently showed that adding enzalutamide to ADT for high risk biochemically recurrent prostate cancer significantly improved 5-year metastasis-free survival. That sounds great, right? Here’s a thoughtful commentary on the EMBARK trial and the larger idea of using more intensive, but non-curative systemic therapies to treat patients with no signs or symptoms of disease besides an elevated biomarker. “Should we treat a number? Does treating early matter? Is spending more time on treatment now worth the potential for treatment-related toxicity or for long-term benefits? What would happen if we simply watch carefully?” MFS is a good surrogate for OS for curative treatments, but not necessarily for non-curative treatment. With immature survival results, the authors ponder whether we are simply delaying the appearance of metastasis or truly preventing it. Finally, in an era of constant hype for the next big systemic agent, we have to remember that these aren’t curative and they can’t substitute for curative salvage treatment (e.g. radiation) in the right patients. | Einstein, J Clin Oncol 2024
