A New Combination in Metastatic Prostate Cancer: Enzalutamide + Radium-223
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Enzalutamide and Radium-223 Prolong Survival in mCRPC with Bone Metastases
The final results of the PEACE-3 phase 3 trial have been announced: combining two powerful treatments sets a new standard in prostate cancer.
In the management of metastatic castration-resistant prostate cancer (mCRPC), bone metastases are the most critical factor directly affecting both patients’ survival and quality of life. The PEACE-3 trial proved that simultaneous use of the standard hormonal treatment enzalutamide and the radiopharmaceutical agent radium-223 significantly increases survival compared with hormonal treatment alone. This combination offers a strong “first-line” option, particularly for individuals with bone-dominant disease.
A marked increase in survival: median survival of 38.2 months
The final data shared as of January 2026 showed much better results in the combination arm after a median follow-up of 58 months. The study’s principal investigator, Dr. Enrique Gallardo, emphasized that this combination reduced the risk of death by 24% compared with enzalutamide monotherapy (HR 0.76).
The study not only prolonged survival but also substantially delayed radiological disease progression (rPFS). Patients receiving the enzalutamide and Radium-223 combination reached a median rPFS of 19.2 months.
Key Findings: The Success of PEACE-3 in Numbers
This duration achieved with combination treatment is 5.6 months longer than the 32.6 months in those receiving enzalutamide alone.
With an rPFS of 19.2 months, the combination group outperformed enzalutamide (16.4 months) in keeping the disease under control.
The safety profile was optimized by making use of a bone-protecting agent (denosumab/zoledronic acid) mandatory to prevent fracture risk.
Manageable side effects and points requiring attention
As expected, combination treatment had a slightly higher side-effect profile than single-agent treatment. Although grade 3 or higher adverse effects, particularly hypertension, anemia, and neutropenia, were more frequent in the combination arm, no major jump exceeding 5% was recorded for individual adverse effects.
In conclusion, the PEACE-3 trial scientifically established that the “first-line” combination of enzalutamide and 6 cycles of radium-223 provides both rPFS and OS advantages in mCRPC patients with bone metastases. These data are strong enough to lead to updates in oncology guidelines.
An era of joining forces in oncology
One of the greatest challenges in prostate cancer treatment is both relieving the pain of disease that has spread to bone and slowing its course. The PEACE-3 trial shows us that attacking cancer through two different mechanisms (one hormonal, the other bone-targeted alpha radiation) can prolong survival by almost half a year.
The most critical detail in this success is the use of bone-protecting agents. In oncology, healing is not simply giving the strongest drug, but preserving the patient’s quality of life by managing that drug’s side effects in the best possible way. With the right patient selection and supportive treatments, this combination is a candidate to become a new gold standard in mCRPC management.
Scientific references
- 1. Gallardo E, et al. Combination enzalutamide and radium-223 extends OS in bone-dominant mCRPC in Phase 3 Trial. ASCO Daily News, Feb 2026.
- 2. EORTC-1333/PEACE-3 Study: Radium-223 plus Enzalutamide in Metastatic Castration-Resistant Prostate Cancer. Annals of Oncology / ASCO GU 2026 Symposium.
- 3. Gillessen S, et al. Radiographic Progression-Free Survival and Final OS Results from PEACE-3 trial.
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