Abstract
There was no clear evidence whether the initial dose of enzalutamide affects the incidence of adverse events (AEs), and oncological outcome in patients with castration-resistant prostate cancer (CRPC). The clinical charts of 233 patients with CRPC treated with enzalutamide were reviewed retrospectively. After 1:3 propensity score matching (PSM), 124 patients were divided into a reduced dose group and a standard dose group, and the prostate specific antigen (PSA) response and the incidence of AEs were compared. 190 patients with CRPC initiated with standard dose enzalutamide were younger and better performance status compared with 43 patients beginning with reduced dose. After PSM, the baseline characteristics were not different between the standard and the reduced dose group. In the PSM cohort, the PSA response rate was significantly lower in the reduced dose group than in the standard dose group (-66.3% and -87.4%, p = 0.02). The incidence rates of AEs were not statistically different between the groups (22.6% and 34.4%, respectively, p = 0.24). Initiating treatment with a reduced dose of enzalutamide did not significantly decrease the incidence rate of AEs, and it showed poorer PSA response rate. There is no clear rationale for treating with a reduced initial dose of enzalutamide to reduce the incidence of AEs.
Highlights
Prostate cancer (PC) is the most common type of cancer among elderly men worldwide [1]
There was no clear evidence whether the initial dose of enzalutamide affects the incidence of adverse events (AEs), and oncological outcome in patients with castration-resistant prostate cancer (CRPC)
190 patients with CRPC initiated with standard dose enzalutamide were younger and better performance status compared with 43 patients beginning with reduced dose
Summary
Prostate cancer (PC) is the most common type of cancer among elderly men worldwide [1]. Enzalutamide, a next-generation androgen receptor (AR)-targeted agent, was approved for metastatic CRPC based on the results of phase 3 double-blind, randomised trials (PREVAIL and AFFIRM) [4, 5] In these trials, enzalutamide significantly prolonged patient survival compared to placebo in both pre- and post-chemotherapy settings. Approximately 95% of patients in the enzalutamide arm had varying severity of AEs such as decreased appetite, weight loss, and fatigue [9] Among such AEs, fatigue is the most frequent, with an incidence of 35.6% and 21.4% in the overall population and the Japanese subgroup of the PREVAIL trial, respectively [4, 9]. There was no clear evidence whether the initial dose of enzalutamide affects the incidence of adverse events (AEs), and oncological outcome in patients with castration-resistant prostate cancer (CRPC)
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