Exploring Key Prostate Trials Prior to 2026 ASCO GU Cancers Symposium

In an interview previewing the 2026 ASCO Genitourinary Cancers Symposium, Charles B. Nguyen, MD, of City of Hope Cancer Center, Duarte, California, discussed the evolving clinical relevance of the phase 3 PEACE-3 trial (NCT02194842), which evaluates enzalutamide (Xtandi) plus radium-223 (Xofigo) compared with enzalutamide monotherapy in metastatic castration-resistant prostate cancer (mCRPC).

Nguyen explained that PEACE-3 is a randomized study enrolling patients with mCRPC and bone metastases who were asymptomatic or only mildly symptomatic and had no prior exposure to either therapy. Participants were assigned to receive enzalutamide alone or enzalutamide combined with 6 cycles of radium-223. He noted that the trial population was largely androgen-receptor pathway inhibitor (ARPI)–naïve, reflecting the treatment landscape at the time the study was initiated.

He reviewed previously reported findings, highlighting that an interim analysis demonstrated an improvement in radiographic progression-free survival with the combination approach, while overall survival data were not yet mature at that time. According to Dr Nguyen, the upcoming presentation will include the final overall survival analysis, and the recently released abstract indicates that the combination improves overall survival compared with enzalutamide alone.

Dr Nguyen emphasized that these results are notable because they may renew interest in radium-223 at a time when treatment paradigms have increasingly focused on other systemic approaches, including newer targeted and radioligand strategies. However, he also pointed out an important limitation in applicability: the study population represents a group of first-line mCRPC patients without prior ARPI exposure, a scenario that is becoming less common as these agents are used earlier in the disease course.

Overall, he characterized PEACE-3 as a compelling study that both demonstrates a survival benefit for the combination and prompts discussion about how best to integrate these findings into a rapidly evolving treatment landscape.