Safety of antiandrogen therapy for treating prostate cancer. Expert opinion on drug safety. By Ricci et al 2014
Key sentence from the paper: “In selected groups of hormone-sensitive patients with locally advanced disease, non-steroidal antiandrogen monotherapy appears to yield comparable results as castration, with the advantage of allowing preservation of gonadal function and of reducing the incidence and severity of the side effects associated with ADT.”
For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25270521
Commentary: As the new super antiandrogen enzalutamide (Xtandi) gets increasing attention from both clinicians and researchers, there is a growing interest in general in the use of antiandrogens to treat prostate cancer. This large, comprehensive review comes out of Italy, which is not surprising since physicians outside North Americaare more likely to prescribing high-dose antiandrogen (specifically 150 mg daily Casodex = Bicalutamide) than physicians in either Canada or the United States. Here in North America antiandrogen monotherapy is discouraged because of concerns about liver toxicity. However, this treatment needs to be reconsidered in light of our growing knowledge about the toxicity of the alternative, i.e., the LHRH drugs.
The authors of this review make a reasonable case for Casodex monotherapy particularly for patients, who are be at high risk of lethal cardiac events on LHRH drugs. It should also be acknowledged that in many places in the world patients can’t afford the LHRH drugs and antiandrogen monotherapy is their best treatment option. In terms of side effect profile, the antiandrogens most conspicuous side effects are estrogenic, which can be seen as good or bad. So, for example, anti-androgen monotherapy increase the incidence of gynecomastia and breast pain. However anti-androgen monotherapy appears to help preserve sexual interest and function better that any of the LHRH drugs use to treat prostate cancer.
Ricci F, Buzzatti G, Rubagotti A, Boccardo F. Safety of antiandrogen therapy for treating prostate cancer. Expert opinion on drug safety. 2014:1-17.