Efficacy of Enzalutamide in Castrate-Resistant Prostate Cancer in Men with Visceral Metastases

We know that men with metastatic castration-resistant prostate cancer (mCRPC) and visceral metastases have a worse prognosis than those with non-visceral metastases. The important question we need to understand is what, of our currently available treatments, might be effective for this more aggressive and deadly type of prostate cancer? Results of the phase 3 AFFIRM clinical trial have demonstrated that treatment with the androgen receptor inhibitor enzalutamide (Xtandi) resulted in significant improvements in outcomes for men with mCRPC. This blog post discusses the efficacy of enzalutamide among men from the AFFIRM trial who had visceral disease. Men who were in [...]

Abiraterone And Enzalutamide Effect Cognitive Impairment and Depression in Men With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Speaking with men who have taken abiraterone (Zytiga, ABI) and enzalutamide (Xtandi, ENZA), at Malecare we sometimes hear reports of both cognitive and mood changes brought on by these two drugs. Evaluating these two problematic side effects researchers have confirmed our experience, both of these drugs can cause these symptoms and that more men reported depression and a trend towards an increase in cognitive impairment with ENZA as compared to ABI. If you experience any of these symptoms you should discuss them with your doctor. Don't suffer in silence. J Clin Oncol 34, 2016 (suppl; abstr 5059); Parimi, Eigl, Sunderland, [...]

An Independent Prognostic Tool For Men With Metastatic Castrate Resistant Prostate Cancer Taking The Newer Drugs

We have a number of newer hormone pathway drugs now available to treat men with metastatic castrate resistant prostate cancer (mCRPC). Researchers have shown that prostate specific antigen (PSA) response can be used as a pharmaco-dynamic end-point that may help identify men with early resistance to these new drugs. They found that there is clinical significance of an early PSA response (EPR) during therapy with enzalutamide, abiraterone acetate (AA) and orteronel in mCRPC. The researchers evaluated PSA values at baseline and then 28 days after beginning treatment in men who were recruited from other clinical trials. They defined EPR as a decline [...]

Prostate Cancer drugs cost more in the USA than in other countries.

The cost of Enzalutamide (Xtandi) in the United States is being challenged by Knowledge Ecology International (KEI), a public interest advocacy group.  The average US wholesale price of Xtandi in 2015 was $88 per capsule.   That can add up to $129,000 annual cost per man. There are significant issues related to high costs of treatment. The higher the cost, the more likely that insurance companies will  require pre-authorization to cover the cost of the drug.  That means a man dealing with advanced stage disease is tasked with asking his doctor to spend uncompensated time fighting the insurance company for his [...]

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