Enzalutamide in systemic treatment of prostate cancer

Abstract

Prostate cancer is one of the most common tumours in the human population and the most frequently diagnosed among genitourinary tumours. Despite relatively high efficacy of systemic treatment in prostate cancer, it is still one of the most important causes of premature cancer mortality in men. There are several causes of this phenomenon. One of the most important reasons for such are complications of disease spread and localisation of metastatic lesions. Others include complications related to implemented treatment, especially if chemotherapy is being administered. However, it is still the specific biological transformation and tumour evolution into state of resistance to castration (CRPC), which develops with time and under hormonal therapy, that is the major clinical challenge. Progress in the field of molecular biology enabled identification of the crucial role of signal transduction pathway dependent on the androgen receptor (AR) in CRPC. Enzalutamide is the first anti-androgen that interferes with the mechanism of progression related to AR gene amplification and/or AR over-expression. The results of the PREVAIL phase 3 trial in a population of men with metastatic CRPC not previously exposed to docetaxel were presented at ASCO GU 2014. These data prove a significant advantage of enzalutamide use over placebo in regard to all study end-points. Enzalutamide is a drug that prolongs progression-free survival and overall survival in different populations of men with CRPC.