There was a recent interview in the Pharma Strategy Blog with Dr. Bertrand Tombal , an academic urologist in Belgium. Dr. Tomal discussed several of the new advances in the treatment od advanced prostate cancer with an emphasis on the potential future of Enzalutamide (Xtandi).
Like bicalutamide (Casodex), Xtandi works by blocking (inhibiting) testosterone from interacting with the prostate cancer cell. However, it is more effective and has been described as a “super” bicalutamide (Casodex).
In Europe hormone therapy (ADT) differs from the standard in the United States. In the United Sates ADT uses drugs that are agonists, or that minimize the production of testosterone, sometimes along with bicalutamide and sometimes with bicalutamide for only a short period of time when first starting therapy.
Traditionally, in Europe the agonist drugs are not used, but instead the ADT is the use of solely bicalutamide at a higher dose. This method is attractive, as it seems to have a lower side effect profile.
Xtandi, or the “super “ inhibitor has been approved for use in the United States only after chemotherapy failure, but Dr. Tomal has raised the question about using Xtandi earlier in the process as the initial ADT. He has indicated that in a trial he conducted in Europe, the response rate from men who are still hormone responsive (remember chemotherapy is used with men who are no longer hormone sensitive) was remarkable and “profound.” He reported that not only was there a profound PSA response, but that there was also a surprisingly positive tumor response.
Dr. Tomal’s interview can be read and heard at: Interview
Joel T. Nowak, M.A., M.S.W.
Avoiding the use of agonists for BCR only has always appeared to be very attractive option. The side effects of the tradtional ADT that we use in the states is not something I am looking forward to but will likely face in the near future. Hopefully we can learn from our neighbors across the pond and offer this type of alternative treatment.