Abiraterone or Enzalutamide in Chemotherapy-Naïve Metastatic CRPC
The current standard of care for metastatic prostate cancer is androgen deprivation therapy (ADT); however, after 5 years, significant patients undergo disease progression despite hormonal manipulation and castrate testosterone levels [1, 2]. Multiple new treatment agents have been developed for men with metastatic castration-resistant prostate cancer (mCRPC) including chemotherapeutic agents, such as docetaxel and cabazitaxel [3–5]. Docetaxel and cabazitaxel are the only US Food and Drug Administration (FDA)-approved chemotherapeutic agents for the mCRPC treatment, decrease PSA levels, and palliate symptoms, but survival benefits are limited. Also, use of systemic chemotherapy generally be reserved for men with symptomatic mCRPC and may be limited by the presence of pre-existing medical conditions and the risk of developing adverse effects . Because the androgen receptor (AR) activates PSA gene expression, more understanding of the role of the AR in prostate cancer progression has led to the improvement of treatment strategies to further suppress AR signaling in mCRPC . Both abiraterone acetate and enzalutamide have been studied and shown to prolong overall survival in large phase III trials in the chemotherapy-naïve mCRPC settings.
- 12.Ryan CJ, Smith MR, Fizazi K, Saad F, Mulders PF, Sternberg CN, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015;16(2):152–60.CrossRefPubMedGoogle Scholar
- 14.Rathkopf DE, Smith MR, de Bono JS, Logothetis CJ, Shore ND, de Souza P, et al. Updated interim efficacy analysis and long-term safety of abiraterone acetate in metastatic castration-resistant prostate cancer patients without prior chemotherapy (COU-AA-302). Eur Urol. 2014;66(5):815–25.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Basch E, Autio K, Ryan CJ, Mulders P, Shore N, Kheoh T, et al. Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial. Lancet Oncol. 2013;14(12):1193–9.CrossRefPubMedGoogle Scholar
- 19.Loriot Y, Miller K, Sternberg CN, Fizazi K, De Bono JS, Chowdhury S, et al. Effect of enzalutamide on health-related quality of life, pain, and skeletal-related events in asymptomatic and minimally symptomatic, chemotherapy-naive patients with metastatic castration-resistant prostate cancer (PREVAIL): results from a randomised, phase 3 trial. Lancet Oncol. 2015;16(5):509–21.CrossRefPubMedGoogle Scholar