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Enzalutamide

Enzalutamide, also known as MDV3100 or Xtandi, is a drug being studied in clinical trials for the treatment of prostate cancer, particularly castration-resistant prostate cancer (CRPC). This article summarizes key findings from various clinical trials investigating the safety, efficacy, and pharmacokinetics of enzalutamide in patients with prostate cancer.

Table of Contents

What is Enzalutamide?

Enzalutamide is a medication primarily used in the treatment of prostate cancer. It’s also known by its brand names Xtandi and MDV3100 [8]. This drug belongs to a class of medications called androgen receptor inhibitors, which work by targeting the hormones that fuel prostate cancer growth.

How Does Enzalutamide Work?

Enzalutamide works by blocking the effects of androgens (male hormones like testosterone) in the body. Specifically, it blocks testosterone in cells [1]. This is important because many prostate cancers rely on androgens to grow and spread. By blocking these hormones, enzalutamide can help slow down or stop the growth of prostate cancer cells.

Conditions Treated with Enzalutamide

Enzalutamide is primarily used to treat several types of prostate cancer:

  • Metastatic Castration-Resistant Prostate Cancer (mCRPC): This is an advanced form of prostate cancer that has spread to other parts of the body and no longer responds to treatments that lower testosterone levels [7].
  • Non-metastatic Castration-Resistant Prostate Cancer: This is a type of prostate cancer that has not yet spread beyond the prostate but is no longer responding to hormone therapy that lowers testosterone [3].
  • Metastatic Castration-Sensitive Prostate Cancer (mCSPC): This is prostate cancer that has spread beyond the prostate but still responds to treatments that lower testosterone levels [2].

Interestingly, enzalutamide has also been studied for potential use in certain types of breast cancer, specifically in patients with advanced, androgen receptor-positive, triple-negative breast cancer [5].

Dosage and Administration

Enzalutamide is typically taken orally, usually once daily. The standard dose is often 160 mg per day, which is usually administered as four 40 mg capsules [8]. However, the exact dosage may vary depending on the specific condition being treated and the patient’s individual health status. It’s important to take enzalutamide exactly as prescribed by your doctor.

Clinical Trials and Effectiveness

Numerous clinical trials have been conducted to evaluate the effectiveness of enzalutamide in treating various stages of prostate cancer. Here are some key findings:

  • Improved Progression-Free Survival: In patients with non-metastatic castration-resistant prostate cancer, enzalutamide significantly improved metastasis-free survival compared to placebo [3].
  • PSA Response: Many studies have shown that enzalutamide can lead to a significant reduction in PSA (Prostate-Specific Antigen) levels, which is a marker used to monitor prostate cancer [8].
  • Overall Survival: Some studies have demonstrated improved overall survival in patients treated with enzalutamide compared to standard treatments [3].

Side Effects and Safety Considerations

Like all medications, enzalutamide can cause side effects. Common side effects may include:

  • Fatigue or weakness
  • Hot flashes
  • Headache
  • Dizziness
  • Decreased appetite
  • Constipation or diarrhea
  • Joint pain

More serious side effects, though less common, can include seizures, falls, and fractures [3]. It’s important to discuss all potential side effects with your healthcare provider and report any unusual symptoms promptly.

Combination Therapies with Enzalutamide

Researchers are exploring the potential benefits of combining enzalutamide with other treatments to enhance its effectiveness. Some combinations being studied include:

  • Enzalutamide with Talazoparib: This combination is being studied in patients with metastatic castration-resistant prostate cancer [2].
  • Enzalutamide with PF-06821497 (Mevrometostat): This combination is being investigated for its potential to improve outcomes in metastatic castration-resistant prostate cancer [7].
  • Enzalutamide with Mifepristone: This combination is being studied in patients with metastatic breast cancer [6].

These combination therapies are still in the research phase, and their effectiveness and safety are being evaluated in clinical trials.

Aspect Details
Drug Name Enzalutamide (MDV3100, Xtandi)
Primary Indication Metastatic Castration-Resistant Prostate Cancer (mCRPC)
Administration Oral, typically 160 mg daily
Key Outcomes Measured Overall Survival, Progression-Free Survival, PSA Response, Safety
Common Side Effects Fatigue, nausea, hot flashes, diarrhea
Trial Phases Phase I, II, and III studies conducted
Patient Populations mCRPC patients, including those previously treated with docetaxel or abiraterone
Pharmacokinetic Studies Conducted to assess drug absorption, distribution, and elimination

FAQ

  • What is enzalutamide and how does it work? Enzalutamide is a drug used to treat prostate cancer. It works by blocking the effects of androgens (male hormones) in the body, which can slow down or stop the growth of prostate cancer cells.
  • What types of prostate cancer is enzalutamide being studied for? Enzalutamide is primarily being studied for metastatic castration-resistant prostate cancer (mCRPC), which is an advanced form of prostate cancer that has spread to other parts of the body and no longer responds to hormone therapy that lowers testosterone.
  • What are the common side effects of enzalutamide? Common side effects of enzalutamide may include fatigue, nausea, hot flashes, and diarrhea. However, the specific side effects can vary between patients and should be discussed with a healthcare provider.
  • How is enzalutamide administered? Enzalutamide is typically administered orally, usually as capsules or tablets, once daily. The standard dose in many trials is 160 mg per day, but this can vary depending on the specific study and patient factors.
  • What are some of the key outcomes being measured in enzalutamide clinical trials? Key outcomes being measured in enzalutamide trials include overall survival, progression-free survival, prostate-specific antigen (PSA) response, time to PSA progression, and safety assessments such as adverse events and changes in vital signs.

Ongoing Clinical Trials on Enzalutamide

  • Study of Talazoparib and Enzalutamide combination treatment for patients with metastatic prostate cancer who previously received Abiraterone

    Recruiting

    2 1 1 1
    Investigated drugs:
    France Spain

  • Study on the Effectiveness of Abiraterone, Capivasertib, and Enzalutamide in Patients with Metastatic Prostate Cancer

    Recruiting

    3 1 1 1
    Investigated diseases:
    Investigated drugs:
    Belgium Norway Sweden

  • Study on Radiotherapy and Antiandrogens for Patients with Advanced Prostate Cancer Using Abiraterone Acetate and Enzalutamide

    Recruiting

    2 1 1 1
    Investigated diseases:
    Investigated drugs:
    Spain

  • Study on Shortened Treatment with Apalutamide and Enzalutamide for Patients with Low-Volume Metastatic Castration-Sensitive Prostate Cancer

    Recruiting

    3 1 1 1
    Investigated diseases:
    Investigated drugs:
    The Netherlands

  • Study on the Effectiveness of Triptorelin, Goserelin Acetate, and Enzalutamide in Patients with Oligorecurrent Hormone-Sensitive Prostate Cancer

    Recruiting

    3 1 1 1
    Investigated drugs:
    Belgium

  • Study on the Effect of Metastasis-Directed Therapy with Lutetium (177Lu) Zadavotide Guraxetan in Patients with Advanced Prostate Cancer and Up to 5 Progressive Lesions

    Recruiting

    3 1 1 1
    Investigated diseases:
    Investigated drugs:
    Belgium

  • Study Comparing 177Lu-PSMA-I&T with Apalutamide, Enzalutamide, and Abiraterone for Patients with Metastatic Hormone-Sensitive Prostate Cancer

    Recruiting

    3 1 1 1
    Investigated diseases:
    Investigated drugs:
    Sweden

  • Study of How Enzalutamide and Apalutamide Affect Dexamethasone Processing in the Body in Patients with Prostate Cancer

    Not yet recruiting

    3 1 1 1
    Investigated drugs:
    Sweden

  • Study of Cabozantinib and Atezolizumab Compared to Hormonal Therapy in Adults with Metastatic Castration-Resistant Prostate Cancer

    Not recruiting

    3 1 1 1
    Investigated drugs:
    Belgium Czechia France Germany Greece Italy +3

  • Study of xaluritamig compared to cabazitaxel or androgen receptor therapy for patients with metastatic castration-resistant prostate cancer

    Not recruiting

    3 1 1 1
    Investigated diseases:
    Investigated drugs:
    Austria Belgium Denmark France Germany Greece +5

Glossary

  • Castration-Resistant Prostate Cancer (CRPC): A type of prostate cancer that continues to grow even when the amount of testosterone in the body is reduced to very low levels.
  • Metastatic: Cancer that has spread from its original site to other parts of the body.
  • Pharmacokinetics: The study of how a drug is absorbed, distributed, metabolized, and eliminated by the body.
  • Prostate-Specific Antigen (PSA): A protein produced by the prostate gland. Elevated levels may indicate prostate cancer or other prostate conditions.
  • Progression-Free Survival (PFS): The length of time during and after treatment that a patient lives with the disease but it does not get worse.
  • Overall Survival (OS): The length of time from either the date of diagnosis or the start of treatment that patients are still alive.
  • Adverse Event (AE): Any unfavorable and unintended sign, symptom, or disease temporarily associated with the use of a medical treatment or procedure.
  • Bioavailability: The proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect.
  • Dose-Limiting Toxicity (DLT): Side effects of a drug or other treatment that are serious enough to prevent an increase in dose or level of that treatment.
  • Maximum Tolerated Dose (MTD): The highest dose of a drug or treatment that does not cause unacceptable side effects.

References

  1. https://clinicaltrials.gov/study/NCT03196388
  2. https://clinicaltrials.eu/trial/study-of-talazoparib-and-enzalutamide-for-men-with-metastatic-castration-sensitive-prostate-cancer-with-ddr-gene-mutations/
  3. https://clinicaltrials.gov/study/NCT02003924
  4. https://clinicaltrials.gov/study/NCT02384382
  5. https://clinicaltrials.gov/study/NCT01889238
  6. https://clinicaltrials.gov/study/NCT06099769
  7. https://clinicaltrials.eu/trial/study-of-pf-06821497-with-enzalutamide-for-men-with-metastatic-castration-resistant-prostate-cancer-previously-treated-with-abiraterone-acetate/
  8. https://clinicaltrials.gov/study/NCT01664923