Abiraterone [Zytiga] or Enzalutamide [Xtandi]?

[pjoshea13]

Abi or Enza? For men with cardiovascular issues or hypertension, a new study [1] might influence the decision.

"The retrospective analysis, which was published in Prostate Cancer and Prostatic Diseases, showed that the ASIs abiraterone acetate (Zytiga) and enzalutamide (Xtandi) both increased cardiotoxicity risk, but that their specific impact varied. The overall risk of cardiac disorders was higher with abiraterone versus enzalutamide; whereas enzalutamide was associated with a higher risk of hypertension." [2]

***

"Background: Abiraterone and enzalutamide may increase the risk of cardiovascular events in patients with castration-resistant prostate cancer (CRPC).

"Methods: A comprehensive literature search was performed using a combination of keywords related to "abiraterone," "enzalutamide," "prostate cancer," and "adverse events." Phase II-IV randomized controlled trials (RCTs) on abiraterone or enzalutamide for patients with nonmetastatic or metastatic CRPC were included. Outcome measures included (1) any grade cardiac disorder, (2) severe grade cardiac disorder, (3) any grade hypertension, and (4) severe grade hypertension, as defined by the Common Terminology Criteria for Adverse Events. Pairwise meta-analysis and Bayesian network meta-analyses were performed to investigate the risk ratios (RRs) of abiraterone and enzalutamide. Surface under cumulative ranking curves (SUCRAs) and cumulative ranking probability plots based on the probability of developing cardiac disorders or hypertension were presented.

"Results: A total of 7103 patients from seven RCTs were included. Upon pairwise meta-analysis, abiraterone was associated with increased risks of any grade (RR = 1.34, 95% confidence interval (CI) = 1.05-1.73) and severe grade cardiac disorders (RR = 1.71, 95% CI = 1.16-2.53); enzalutamide was associated with increased risks of any grade (RR = 2.66, 95% CI = 1.93-3.66) and severe grade hypertension (RR = 2.79, 95% CI = 1.86-4.18). Based on the SUCRA rankings, abiraterone had a higher probability of cardiac disorders (84.84% for any grade and 85.12% for severe grade) than enzalutamide (62.83% for any grade and 50.76% for severe grade); whereas enzalutamide had a higher probability of hypertension (99.43% for any grade and 89.71% for severe grade) than abiraterone (49.08% for any grade and 49.37% for severe grade).

"Conclusions: Abiraterone and enzalutamide had different adverse effects on the cardiovascular system. We should take this into consideration when we are deciding on the choice of novel hormonal agents for patients with CRPC."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/328...

[2] urologytimes.com/view/analy...

[LearnAll]

But my personal experience with Abiraterone was that I had serious increase in blood pressure. But I do have family h/o Hypertension. So, now I know that Enza is even more likely to cause increase in BP.

[Hidden]

I had an increase in BP from around 115/65 to 140/80. I'm trying to work it down but not much else I can do that I know of. I think I'll try reducing zytiga from 1000mg a day on an empty stomach to 250mg with a meal.

I take loads of testosterone so I'm not sure how zytiga is helping me.

[Gearhead]

For those of us that started Leuprolide (e.g., Lupron) and Abiraterone (Zytiga) at the same time, how to we distinguish which side effects are associated with which drug? I assume that most of the typical ADT side effects (like libido decrease) are common to both.

[larry_dammit]

Yes. On Xtandi now for 4 years and blood pressure has been running higher as I go alone even with pills to lower the blood pressure. Just another day in paradise ❤️❤️❤️

[j-o-h-n in reply to larry_dammit]

para = for. dise = doing it so easy.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 09/03/2020 6:09 PM DST

[curious-mind1]

If we knew then, what we now know about the Zytiga and Xtandi's effect of hypertension and cardiovascular disease, we would have been more aggressive with the management of the my dad's therapy. In his case, Xtandi horribly elevated his blood pressure to critical levels over the course of a week, and drugs barely brought it down. When he switched to Zytiga, it was more of swings, but was much more manageable. He died of a ruptured aneurysm after five years on those drugs.

If we could do it again, I would have pushed his cardiologist to be much more aggressively watching my dad, a simple MRI would have uncovered aneurysms in the brain, plus more attention would have been paid to his cardio health. This new info should be of great help to men managing their PCa with these effective drugs: make sure you're just as aggressively keeping tabs on hypertension and cardiovascular health.

Art

[monte1111]

My BP was 122/65 on Tuesday. 3 years Xtandi. Take Lisinopril and a few other meds. There was a time I battled very high BP before cancer. Of course the BP is only a part of the overall picture. I used to be a type A person. Now I'm a type Z.