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Baseline serum testosterone and differential efficacy of bipolar androgen therapy and enzalutamide in the randomized TRANSFORMER trial

Bipolar androgen therapy (BAT) is effective in a subset of metastatic castration-resistant prostate cancer (mCRPC) patients. Treatment selection biomarkers are needed due to other therapies that can be equally efficacious. We performed post-hoc analysis to determine whether baseline serum testosterone (T) is a treatment selection marker in the TRANSFORMER study, a randomized trial of abiraterone-pretreated mCRPC patients assigned to BAT (n = 94) or enzalutamide (n = 101). The findings suggest that patients with poor outcomes to abiraterone and serum T ≥ 20 ng/dL may benefit preferentially from BAT over enzalutamide. Baseline testosterone could be considered in the treatment selection process when BAT is an option.

Mayuko Kanayama,1 Hua-Ling Tsai,2 Hao Wang,2 Emmanuel S. Antonarakis,3 Samuel R. Denmeade1,2 & Jun Luo1,2

  1. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600N Wolfe St, Baltimore, MD, USA
  2. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401N Broadway, Baltimore, MD, USA
  3. Department of Oncology, Masonic Cancer Center, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 480, Minneapolis, MN, USA

Source: Kanayama M., Tsai H., Wang H. et al. Baseline serum testosterone and differential efficacy of bipolar androgen therapy and enzalutamide in the randomized TRANSFORMER trial. Prostate Cancer and Prostatic Diseases. (2024). https://doi.org/10.1038/s41391-024-00844-w.