Next month, my husband will be started on a 2nd gen anti androgen.
Are there any specific reasons to prefer one over the other, from a medical standpoint?
We are currently on commercial insurance, and Zytiga would have a copay of $50 a month and Xtandi would be free.
After we go on Medicare next year, we would have a 20% copay for Zytiga, with an annual out of pocket cap of $3960. Xtandi would be free.
My husband does not have a history of seizures or cardiac disease, but he has a slightly fatty liver and his liver enzymes are pushing the upper limits of normal.
If we are eventually going to cycle through both of these drugs, maybe starting with Zytiga would be better? Thoughts?
Written by
leebeth
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Zytiga and Xtandi work by different mechanisms. In simple words, Zytiga is a testosterone blocker whereas Xtandi is an Androgen receptor blocker. AR blockers work by not allowing T/DHT to promote cancer growth.Zytiga blocks all 3 sources of androgens and thus, potentiates the androgen deprivation whereas Xtandi just blocks the receptors where Androgens work. My point is that they are different and both are still effective. The choice requires all the details of a particular case to make a good decision as to which one is more suitable.
And, of course, one doc prefers one and one the other! Thank you.
There is a definite advantage starting with Zytiga and then moving to xtandi if/when Zytiga fails. I just finished my course of zytiga so I can tell you for me the SEs were tolerable but I do notice a difference now that I'm off zytiga.
Here is a meta-analysis of the best sequence for Zytiga [Abiraterone] and Xtandi [Enzalutamide]: [1].
"Seventeen studies met the inclusion criteria."
"Conclusion: Significant clinical efficacy of AAP {abiraterone acetate plus prednisone} administered as the first-line treatment in mCRPC patients followed by enzalutamide, delaying disease progression, compared with the ENZ → AAP sequence. However, more studies and randomized trials are needed, to validate the best treatment sequencing."
Note that the patients (all metastatic) were resistant to first-line treatment [mCRPC].
Fig 2 and Fig 3 give an idea of the effectivity of this drug. Fig 2 shows that the median radiographic free survival has not been reached at 27-30 months.
you're lucky--on medicare with supplement but husband's cost for generic Zytiga would be $1885.15 PER MONTH--out of our price range--have no idea about Xandi
I should add, I can choose my employer’s prescription plan rather than Med D. The cost is high, $236 per month for both of us, and a 20% copay. The attractive thing is the out of pocket max. If we both maxed out, our prescription costs will still be over $10K a year, including premiums. Plus Medicare plus IRMAA plus Supplement.
we've had no problems with part D until now and it's because these drugs are considered "specialty" drugs. The pharmaceutical co. offer "help" but not if on Medicare--the very people who NEED the help paying for drugs like this.....so backwards, but same for all pharmas and high priced drugs. We also shop our part D every year but no way to know what this type drug will cost.pay the big bucks and go bankrupt in senior years or don't get the drug and die---great choice, huh?
It’s our government that doesn’t allow copay cards for Med D. It really needs to be changed. The companies’ hands are tied with Medicare.
The concerning thing with Med D is that there is no annual cap, even in catastrophic coverage. Sure, it’s “only” 5%, but that’s $500 on a $10,000 drug! Insane!
not disagreeing but not sure why gov't would care about RX help for people on medicare and keep them from using copay cards. Whenever I have gone to a Pharma site about getting help with an RX, it only mentions Medicare and not Part D. Just because you have Medicare doesn't mean you have Part D. I know several people who don't have D because they only take 1 or no meds and are willing to risk penalty if they ever do start on D
If the government pays for the prescription, it is excluded from copay cards. So, Medicaid, Medicare, VA. Years ago, many seniors carried commercial insurance from their employers into retirement. Now, nearly everyone is pushed off the commercial plans. It makes no sense to me that the government does not allow copay cards, but that is written into their contracts. Pharma works around it the best they can by offering financial assistance programs.
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