Enzalutamide or Darolutamide

[x-rays1]

Hi,

I have advanced metastatic hormone sensitive prostate cancer and as well as my usual three monthly ADT (Lucrin-Depot) injection, I have been offered either Enzalutamide (Xtandi) or Darolutamide (Nubeqa). My PSA is currently below 0.1 due to the Lucrin-Depot.

I am a bit nervous at taking additional drugs but to help me decide, if I do start them, which one is my best option, I have some questions for anyone in this forum who is taking either of these drugs and are also hormone sensitive. Or anyone with comments that may help me with the decision.

1. How are they handling the additional toxicity?

2. Are they having good results?

3. How did they choose which one to take?

4. How long have they been taking them?

5. Do they believe it provides additional life?

What concerns me is these drugs are used when ADT fails, but ADT has not yet failed for me. Will taking these dugs early shorten the effectiveness? Guess that question is for the crystal ball

I thank in advance, anyone who is able to provide me with help in the decision.

Xray

[Tall_Allen]

There has never been a direct comparison. Unlike enzalutamide, darolutamide isn't approved for recurrent men, like yourself. A new trial found that enzalutamide alone is superior to lucrin alone in this situation.

healthunlocked.com/advanced...

Darolutamide doesn't attach to the GABAA receptor, so it may make you less drowsy, but that hasn't been proven.

Just pick one, and if the side effects are too much, switch to the other.

[x-rays1 in reply to Tall_Allen]

Thank you Tall Allen for your comments.

[podsart in reply to Tall_Allen]

are you saying, other than the blood / brain barrier advantage of Dara, there are absolutely no other advantages of Dara vis a vis Xtandi, especially as to fighting Pca?

[Tall_Allen in reply to podsart]

I think GABAA activation is much more noticeable than penetration of the blood brain barrier, unless one is prone to seizures. There are some differences in the way they act, but Idk if they make an oncological difference. They have never been tested against each other.

[podsart in reply to Tall_Allen]

thanks

[dhccpa in reply to Tall_Allen]

TA, your comment that "neither is approved for recurrent men" confused me a little. So Enzi (with Lupron) is OK with newly diagnosed metastatic PCa, but not for recurrence following RP or initial radiation? Was that what you meant? Thanks.

[Tall_Allen in reply to dhccpa]

Sorry - Xtandi is approved for all mHSPC but Nubeqa isn't yet approved for any mHSPC. I corrected what I wrote - thanks.

[dhccpa in reply to Tall_Allen]

No problem thanks

[Teacherdude72 in reply to Tall_Allen]

I might have read your note wrong but Nubeqa was approved for metastatic hormone-sensitive prostate cancer in August 2022.

[Tall_Allen in reply to Teacherdude72]

No. It was only approved as part of triplet therapy with docetaxel.

[Teacherdude72 in reply to Tall_Allen]

Thanks for the clarification.

[Helmit]

Started Casodex imediately after Dx 1/2020. Xtandi shortly after with lupron depot injection. Get Lupron or Eligard and xgeva after Dx in January, 2020. Have had 3 month injections since, with 160mgm xtandi/daily. Mo said 80 mgm Xtandi/day is OK. Started 80 mgm Xtandi 2 monts ago. PSA has been <0.1 (undetected) for 32 months. No side effects from meds. Response to Tx has been dramatic and MO said that I am in "remission". Hope this will continue . Taking Metformin for borderline Diabetes, type2. Possibly Metformin inhibits cancer cell proliferation. Helment

[x-rays1 in reply to Helmit]

Thank you Helmet for your reply/comments. Can you let me know what your Gleason score and PSA was at diagnosis as it seems your MO put you on Xtandi very quickly. I have also heard that 80 mgm is ok. Can you also please advise what is meant by Tx. Thanks again

[Helmit in reply to x-rays1]

PSA 261, G4+4 Tx is short for treatment. Dx is short for diagnosis. Medical shorthand.

[x-rays1 in reply to Helmit]

Thanks

[hopefull99]

Here is a link for Darolutamide recent information that seems pertinent

onclive.com/view/new-option...

[Warriorthree]

Been on enzalutamide for two and a half years Psa dropped from 2600 to 0.02 and has stayed that way very thankful if covid hadn’t been about I would have had Chemo lost my wife to lung cancer last November so feel there’s nothing left now not scared of death believe in afterlife so can’t wait to meet my beautiful Anita again. Sorry gone off subject a bit had all symptoms hot sweats , irritable legs ,fatigue but bodies got used to them all now and just take 4 tablets a day that’s it

[Apisdorsata]

I was on enzalutamide for about 18 months with Lupron. I had taken Lupron alone for 18 months previously. I had a much, much harder time with the combination. My understanding is that enzalutamide crosses the blood brain barrier. I don't know if daralutamide does.

I will never take enzalutamide again because my QOL was so poor. I had no interest in doing anything other than lying on the sofa. I'm sure it has different effects on different people.

I took 180mg/day. Perhaps in lower dose it would not be so hard to do.

[MateoBeach]

Darolutamide , if you are being offered it. Much better SE profile for many. Especially less fatigue. More effective at resisting failure as less susceptible to loss of function mutations and antagonist to agonist switching. Less seizure risk. It is literally a “no-brainer “ better choice. Though any of these may eventually fail.

[PGDuan]

I was on Enza for about 2 months and then switched to Nubeqa. Found the side effects (fatigue mainly) were not as bad on Nubeqa and have been happy with it since. Both seemed to do the job reducing the PSA.

[dhccpa]

When were you diagnosed with your current metastatic condition? I assume you started Lupron immediately.

[Blueslover]

Been on Lupron now for about 7 years, with the addition of Daralutamide maybe 3 years ago. No extra side effects noticed. Was told at my last visit to Duke that I now had NON-FATAL prostate cancer, guess due to my age of 78 plus non-progression of the nodal Mets. Very happy about this of courseHugh

[Pianodude]

I have been on on Orgovyx for some time now. The MO added Nubeqa, even though I am castrate sensitive. I had no more side effects when it was added.

[Teacherdude72]

All I can say is Nubeqa is used with ADT, Lupron monthly for me. I chose monthly as I feel the longer duration shots weaken or wear off the last few weeks - anecdotal info.

Side effects with Nubeqa are the same as Lupron and for me lower energy and still hot flushes. Energy? Caffeine helps first cup only, gym time 5 days a week some help. Hot flushes no longer bother me.

[Survivor86]

This new study may be of interest: urologytimes.com/view/darol...

[Derf4223]

It concerns non-metastatic PC...

[KocoPr]

Hi Xray, what did you choose enza or dara and how are you doung on it?

[x-rays1 in reply to KocoPr]

Hi KocoPr.

I spent some more time researching it and decided not to go with either due to possibly extra side effects. I’m on ADT and they were suggesting that I could also add Enzalutamide but I decided against it at this stage. The ADT is still keeping my PSA undetectable and I’m keeping my fingers crossed. Good luck.

[KocoPr in reply to x-rays1]

I am presently on Daro and Orgo while still hormone sensitive. I am also on my 20 week 4th cycle of pBAT (testosterone propianate) and doing great. Also for the whole year i was on orgo and daro alone i used 5mg of each Osterine and cardarine. Those mitigated all symptoms except desire. Desire not just for sex but i just don’t have the desire for anymore big projects bit i think that is the cancer psychology.