Xtandi vs. Abiraterone vs. Nubeqa

[shueswim]

So… my recurrence treatment plan consists of RT and ADT & Xtandi for 2 years. I’m still working until January ’23 so cost isn’t a concern until then. My current insurance doesn’t include Xtandi in the formulary - abiraterone & Nubeqa are the covered options. An appeal is underway and coverage seems likely. But looking ahead to January when I transition to Medicare, Xtandi would cost about $12k/ yr. Nubeqa is roughly the same…but abiraterone would only be about $1.5k/yr. Once the current “anti-inflation” bill goes into effect the out of pocket limit will be $2k/yr starting in 2025.

So I’m wondering…how much better are these next generation antiandrogen medications than abiraterone?

[EdBacon]

Abiraterone works really well for a lot of people. I got over 4 years out of it. Despite the price difference, the other anti-androgens out there don't seem to really be significantly better. Abiraterone is the only one that has a generic available, that's why it costs less. You do have to take a low dose of steroids with Abiraterone and long-term use of steroids can lead to dependance as it has with me. Still, it was was well worth it for me and I'd do it again.

[dhccpa in reply to EdBacon]

Doing full dose on empty stomach or 1/4 dose with a meal?

[EdBacon in reply to dhccpa]

I dosed full on an empty stomach.

[Benkaymel]

I haven't used either Zytiga or Xtandi yet but will be starting one or other shortly. Both seem potentially effective but from what I've read, Zytiga seems to have more SE than Xtandi and you have to take the steroid prednisolone alongside it which itself has further SE and as Ed says, can lead to dependence.

Being in the UK on the NHS, cost is not a factor for me so I would prefer to go with Xtandi.

[dhccpa in reply to Benkaymel]

Let us know the outcome. I have that decision looking down the line.

[TEBozo in reply to dhccpa]

Me, too. I'd like to hear. Friend is doing Xtandi as stand alone therapy.

[dhccpa]

If you do the option of 1 pill with a meal for abiraterone, you can cut the cost further by 75%.

[dhccpa]

I guess the key is this: TA says no reliable comparison tests, but AA is dramatically less expensive. Why not do AA until and unless you have negative SEs?

[dhccpa]

You're taking AA on empty stomach (four pills) or 1 pill with meal?

[Olivia007]

Whichever you choose make sure your heart is well enough to tolerate the medications and doesn’t increase your cholesterol levels

[MateoBeach]

Abiraterone is excellent choice of first AAR drug as option to Xtandi.When either of those were to fail, or even as a first choice alternative, Nubequa appears to be the best-of-breed. Both in terms of side effects as it doesn’t get into the brain. And also because it likely has the lowest pathways of resistance from AR mutations. As following article showed. Paul

ncbi.nlm.nih.gov/pmc/articl...

[Benkaymel in reply to MateoBeach]

But isn't darolutamide only used on non-metastatic PCa?

[Purple-Bike]

Is your reason for cycling Zytiga on/off to reduce side-effects?

[Purple-Bike in reply to Purple-Bike]

Sorry, belatedly read your bio. Zytiga is instead of "ordinary" ADT during one phase of BAT