english.prescrire.org > Spotlight > Archives : 2014 > Metastastic prostate cancer: enzalutamide is useful for some patients

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Metastastic prostate cancer: enzalutamide is useful for some patients

In some cases of advanced metastastic prostate cancer, enzalutamide prolongs survival by around 5 months. It is an alternative to abiraterone especially for patients suffering from cardiac or liver disorders.

In men suffering from metastatic prostate cancer, the first-line treatment is androgen deprivation therapy (ADT) (a reduction of male hormone activity) by the ablation of the testicles or drug treatment. In cases of aggravated cancer, cytotoxic chemotherapy may be offered. When the disease progresses despite these initial treatments, oral abiraterone prolongs survival by around 4 months. However it exposes the patient to liver and cardiac disorders.

Enzalutamide has been compared to a placebo in a clinical trial of high-quality methodology involving nearly 1200 patients with aggravated metastatic prostate cancer despite androgen deprivation therapy and cytotoxic chemotherapy. Survival was prolonged by around 5 months.

By indirect comparison only, enzalutamide does not seem to have a better harm-benefit balance than that of abiraterone. Enzalutamide partly shares the adverse effects profile of antiandrogens (hot flushes, diarrhoea, headaches, hypertension), and exposes patients at risk to convulsions, as well as to numerous drug interactions.

Enzalutamide is an alternative to abiraterone, particularly for patients suffering from cardiac or liver disorders, on condition that the risk of convulsions and drug interactions is taken into account.

©Prescrire 1 October 2014

"Enzalumatide. An alternative to abiraterone after docetaxel failure" Prescrire Int 2014; 23 (153): 237. (Pdf, subscribers only).
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See also:

Abiraterone and metastatic
prostate cancer. Delays
pain onset, cytotoxic therapy,
and possibly death
Prescrire Int 2014;
23 (146): 40-41.
Pdf, subcribers only 

First-line treatment of
metastatic prostate cancer.
Androgen suppression for
symptomatic disease
Prescrire Int 2013;
22 (135) : 48-51.
Pdf, subcribers only 

Second-line treatment of
metastatic prostate cancer.
Prednisone and radiotherapy
for symptom relief
Prescrire Int 2013;
22 (136) : 74-78.
Pdf, subcribers only