Hot Paper in Medicine

November 2014
“Increased survival with enzalutamide in prostate cancer after chemotherapy,” by H.I. Scher, et al. (for the AFFIRM Investigators), New England Journal of Medicine, 367(13): 1187-97, 27 September 2012.

Abstract: “BACKGROUND Enzalutamide (formerly called MDV3100) targets multiple steps in the androgen-receptor-signaling pathway, the major driver of prostate-cancer growth. We aimed to evaluate whether enzalutamide prolongs survival in men with castration-resistant prostate cancer after chemotherapy. METHODS In our phase 3, double-blind, placebo-controlled trial, we stratified 1199 men with castration-resistant prostate cancer after chemotherapy according to the Eastern Cooperative Oncology Group performance-status score and pain intensity. We randomly assigned them, in a 2: 1 ratio, to receive oral enzalutamide at a dose of 160 mg per day (800 patients) or placebo (399 patients). The primary end point was overall survival. RESULTS The study was stopped after a planned interim analysis at the time of 520 deaths. The median overall survival was 18.4 months (95% confidence interval [CI], 17.3 to not yet reached) in the enzalutamide group versus 13.6 months (95% CI, 11.3 to 15.8) in the placebo group (hazard ratio for death in the enzalutamide group, 0.63; 95% CI, 0.53 to 0.75; P<0.001). The superiority of enzalutamide over placebo was shown with respect to all secondary end points: the proportion of patients with a reduction in the prostate-specific antigen (PSA) level by 50% or more (54% vs. 2%, P<0.001), the soft-tissue response rate (29% vs. 4%, P<0.001), the quality-of-life response rate (43% vs. 18%, P<0.001), the time to PSA progression (8.3 vs. 3.0 months; hazard ratio, 0.25; P<0.001), radiographic progression-free survival (8.3 vs. 2.9 months; hazard ratio, 0.40; P<0.001), and the time to the first skeletal-related event (16.7 vs. 13.3 months; hazard ratio, 0.69; P<0.001). Rates of fatigue, diarrhea, and hot flashes were higher in the enzalutamide group. Seizures were reported in five patients (0.6%) receiving enzalutamide. CONCLUSIONS  Enzalutamide significantly prolonged the survival of men with metastatic castration-resistant prostate cancer after chemotherapy.”

 

This 2012 report from the New England Journal of Medicine was cited 41 times in current journal articles indexed by Thomson Reuters during May-June 2014. With that latest bimonthly total, this report currently ranks as the third-most-cited paper in medicine published in the past two years, aside from reviews. Prior to the most recent bimonthly count, citations to the report have accrued as follows, as tracked by Essential Science Indicators Hot Papers:

 

March-April 2014: 46 citations
January-February 2014: 49
November-December 2013: 47
September-October 2013: 35
July-August 2013: 39
May-June 2013: 35
March-April 2013: 30
January-February 2013: 26
November-December 2012: 13
September-October 2012: 4

Total citations to date: 365

 

SOURCE: Thomson Reuters Web of Science

The data and citation records included in this report are from Thomson Reuters Web of ScienceTM. Web of ScienceTM is a registered trademark of Thomson Reuters. All rights reserved.