Trial enrollment and referral pathways for community and rural clinicians

Dr. Morgans asks Dr. Agarwal how community and rural clinicians can identify eligible patients for MEVPRO-1 or MEVPRO-2 and discuss trial options with them. Dr. Agarwal recommends ClinicalTrials.gov as the primary resource, where both trials are listed with open sites, contact phone numbers, and emails. Eligibility is straightforward: any patient progressing on abiraterone is potentially eligible for MEVPRO-1, and any patient with mCRPC who has progressed on androgen deprivation therapy (ADT) without prior androgen receptor pathway inhibitor (ARPI) exposure is potentially eligible for MEVPRO-2.

He advises clinicians to identify trial sites within roughly 2–3 hours of the patient's home, since long travel is a non-starter given the requirement for monthly follow-up. For randomization conversations, Dr. Agarwal keeps the framing simple. In MEVPRO-1, he explains that disease has progressed on abiraterone and that the trial offers the combination of mevrometostat plus enzalutamide versus enzalutamide or docetaxel chemotherapy by physician—or patient—choice. He cites prior phase 2 crossover data from the Canadian group (Drs. Daniel Khalaf and Kim Chi) showing enzalutamide retains some activity after abiraterone, and a recent phase 2 trial that found docetaxel performance comparable to lutetium-177 after ARPI progression, supporting both options as appropriate controls.

For MEVPRO-2, the discussion is even simpler: patients have not been exposed to any ARPI and are randomized to enzalutamide plus mevrometostat versus enzalutamide alone. Detailed nuances of trial logistics, side effects, and alternatives are best handled by the enrolling investigator at the trial site.

In the next episode, "Strategic positioning of EZH2 inhibition with enzalutamide in the treatment landscape," Dr. Morgans discusses how this combination compares to taxanes, PARP inhibitors, and radioligand therapy.