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Adding abiraterone to enzalutamide for metastatic castrate-resistant prostate cancer does not improve things


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For metastatic castrate-resistant prostate cancer, Enzalutamide (Xtandi) works.

For metastatic castrate-resistant prostate cancer, Abiraterone (Zytiga) works, but in a different way.

So, perhaps using both at once might be better.

Sorry. No.

Dr Michael Morris reported to the ASCO (American Society of Clinical Oncology) 2019 meeting on the results of the Alliance A031201 clinical trial.

On behalf of the team of doctors that did the trial, Dr Morris said:

  • Adding abiraterone to enzalutamide does not improve OS relative to enzalutamide alone
  • Enzalutamide/abiraterone has a modest improvement in rPFS
  • On-treatment rPFS and OS were similar to previous studies
  • Enzalutamide/abiraterone caused more adverse events than enzalutamide alone
  • The current standard of care is unchanged by this study

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https://www.urotoday.com/conference-highlights/asco-2019-annual-meeting/asco-2019-prostate-cancer/112921-asco-2019-enzalutamide-versus-enzalutamide-abiraterone-and-prednisone-for-metastatic-castration-resistant-prostate-cancer-alliance-a031201.html?utm_source=newsletter_6632&utm_medium=email&utm_campaign=prostate-practice-changing-date-from-asco-2019

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Each was developed for different actions.  For know - at least in the U.S. - enzalutamide/Xtandi (a powerful antiandrogen designed to block access of androgen/testosterone to androgen receptors on cancer cells) is approved for non-metastatic castration resistant prostate cancer (nmCRPC)  when PSA is rising despite, for example, failure of antiandrogens bicalutamide/Casodex, flutamide/Eulexin, or nilutamide/Nilandron.  This medication is also approved for men with evident metastasis.  Abiraterone/Zytiga (a powerful blocker of androgen/testosterone produced by testicular, adrenal glands, and that produced within cancer cells) is only approved when metastasis is evident.  Apparently their combined use inhibits the effectiveness of the other.  Not only that, but with the cost of each already quite prohibitive, it is unlikely health insurers would support combined use and cost. One would hope that abiraterone/Zytiga is eventually approved for use for men with nmCRPC since its use could be very effective to stave off metastasis when LHRH/GnRH antagonists/agonist appear to be showing failure in controlling androgen/testosterone production.

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When Casodex stopped working for me, Enzalutamide, immediately dropped my psa to <0.01 but after 4 months I had a mild seizure, attributed to it. I was changed to Aberiterone which is just as effective in controlling my psa but has no side effects for me at all.( no change in psa for 13 months).

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Rosco

That is good news.

Did you have any previous history of seizures?

 

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No, none. However, in the 4 weeks prior I had two episodes whilst driving in the country when I could not remember having made a route turn and after driving several kilometres I stopped and turned back to reassure that I was on the right road. These were 4 weeks then 2 weeks before my seizure. Since changing to Aberiterone my memory is very sharp.

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