Zytiga vs xtandi

[Magnus1964]

Impact of Abiraterone Acetate Plus Prednisone or Enzalutamide on Patient-Reported Outcomes in Patients With Metastatic Castration-Resistant Prostate Cancer

European Association of Urology

TAKE-HOME MESSAGE

AQUARiUS (NCT02813408) was a prospective, 12-month, European observational study including 211 patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate or enzalutamide. Patient-reported outcomes (PROs), including quality of life, cognitive function, fatigue, and pain, were reported at 12 months among groups. At 12 months, important PROs significantly favored abiraterone versus enzalutamide, including fatigue and asthenia (5% vs 15% and 10% vs 11%, respectively), and fewer patients treated with abiraterone experienced clinically meaningful worsening episodes of cognition or fatigue.

In this real-world setting with 1-year follow-up, these data suggest an advantage of abiraterone acetate over enzalutamide in terms of the effect on quality of life in patients with mCRPC.

– Pedro C. Barata, MD

[Fairwind]

(5% vs 15% and 10% vs 11%, respectively),

Not that significant..

[cesces]

Is this contrary to conventional wisdom or supportive of it?

[Magnus1964 in reply to cesces]

I far as I am aware this is the first comparative study. But as Fairwind points out the the difference is not that significant.

[Sxrxrnr1 in reply to Magnus1964]

Almost 2 years ago I chose Xtandi monotherapy(no ADT) as I wished to avoid many of the severe side effects of testosterone deprivation,,,,which of course Zytiga dishes out in spades because of its methodology of inhibiting the cyp17 enzyme which is a critical primary ingredient in the production of testosterone.

Worked very well for 15 months, PSA in 2 months fell from 374 to 10, testosterone rose from high 300’s to almost 1,000, libido was as a raging bull, erections same, bone density maintained with no degradation, no cardio events, diabetes, Etc.

Xtandi side effect was intense fatigue,,,likely would have experienced on ADT.

When Xtandi at 15 months(they all do eventually unfortunately) failed, PSA begin to go wild( 5 week doubling time) went to Casodex,,,against recommendation of my MO’s. Worked very well, PSA in a month dropped from 400 or so to 150.

Darolutamide now approved, been on with Lupron for 3 weeks. Incidentally I had completely and instantly failed Lupron previously. I am on now because is a requisite for Darolutamide. My butt is being kicked in fatigue and God only knows(yes I too am learning) all other areas,,,,I doubt fatigue is Nubeqa,,,I am almost certain is completely ineffective Lupron. Nubeqa is purported to have minimal fatigue issues itself,,,so the claim.

Yes I am aware of theories suggesting that even if ADT resistant,,there is medical reasons to stay with it.

I suspect this is more SOC theory from 60 years ago and not science driven,,,just as continuing Lupron while on Zytiga,,,,which some are now seeing the light of day on.

[Magnus1964 in reply to Sxrxrnr1]

Thanks for the reply. I didn't know Lupron is a requisite for Darolutamide. More research.