Enzalutamide Combo Improves OS in Prostate Cancer Without Sacrificing Quality of Life: Stephen Freedland, MD

In patients with high-risk biochemically recurrent prostate cancer, combination enzalutamide and leuprolide significantly reduced the risk of death compared with leuprolide alone, according to data presented at the 2025 European Society for Medical Oncology Congress.¹

The phase 3 EMBARK trial (NCT02319837) demonstrated a 40.3% reduction in the risk of death with enzalutamide plus leuprolide vs leuprolide alone (HR, 0.597; 95% CI, 0.444-0.804; P = .0006). With these findings in mind, study investigator Stephen Freedland, MD, noted that the evidence supporting use of the combination is stronger than ever. Freedland is director of the Center for Integrated Research in Cancer and Lifestyle and associate director for training and education at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai.

This transcript has been lightly edited; captions are auto-generated.

Transcript

How do you anticipate the EMBARK findings will translate into real-world clinical practice, particularly regarding identifying appropriate patients and balancing treatment intensity with quality of life?

I think one of the great things about EMBARK is these are patients that are conventional imaging negative. They don't have any symptoms from the cancer. If you hadn't done a blood test, they wouldn't even know they had cancer. They're living their best life; they're out there. Yes, they had surgery, and yes, they had radiation—sometimes both—so that they're dealing with some side effects of that but otherwise are doing great. We have all these cancer benefits: we're delaying progression, and we're improving overall survival. It's a wonderful, wonderful thing, but the question is, at what cost to quality of life?

We actually looked at that very carefully, and with patient-reported outcomes measured every 12 weeks, in the global sense, we could not find any difference in quality of life, really relative to even baseline, between enzalutamide—with or without ADT [androgen deprivation therapy]—and ADT. We are preserving the quality of life, which I think is a really important thing—that we don't need to sacrifice the quality of life to get that quantity of life.

It's already in the guidelines; I would be hopeful that after the overall survival is out there, the level of evidence will be upgraded, at least for the combination, to level 1 evidence. I would be hopeful on that. But it's in there in the guidelines, I think people are using it, and this just gives us even more confidence that we really can prolong quantity of life without sacrificing quality of life.

Reference

Freedland S, Shore ND, De Almeida Luz M, et al. EMBARK: overall survival with enzalutamide in biochemically recurrent prostate cancer. Presented at: 50th European Society for Medical Oncology Congress; October 17-21, 2025; Berlin, Germany. Abstract LBA87.