What are the pros and cons of using enzalutamide (Xtandi) to treat advanced prostate cancer before or after chemo?

This study involved 140 patients with castrate resistant disease. The major focus was on side effects and PSA control over time. 57% of the patients, who had not had chemotherapy showed a >50% decrease in PSA, and 53% of those who had chemo showed a PSA decrease of similar magnitude. A quarter to a third of the patients in the two groups respectively showed PSA decreases of >90%. But the adverse effects were not inconsequential. The most common ones were fatigue (70%), nausea (40%) and constipation (32%). Half the patients had at least one side effect that was rated as severe. Fatigue was rates as such in 14% of the patients.


Higano CS, Beer TM, Taplin ME, Efstathiou E, Hirmand M, Forer D, Scher HI. 2015. Long-term safety and antitumor activity in the phase 1-2 Study of enzalutamide in pre- and post-docetaxel castration-resistant prostate cancer. Eur Urol 68(5):795-801. www.ncbi.nlm.nih.gov/pubmed/25698064