Efficiency between Erleada & Zytiga?

[StayingOptimistic]

I need to make a decision between Erleada and zytiga for metastatic ( by psma to LN) HS prostate cancer. Which one should I choose based on efficacy.

I am sure some of you are familiar with clinical trials.

Thanks for your input.

[treedown]

It seems to me the 3 lutamides, Daro, Enza and Apo are all considered newer drugs and my recent experience with enzalutamide sure seemed a lot harder on my body than Zytiga. Pretty sure I read that Darolutamide beat out Zytiga but Erleada is made by the same company as Zytiga so the only thing I can find is where they tried to do both but decided against pursuing it further and are just pushing them seperately.

If you have been on Zytiga in the past and choose Erleada I will be interested in your experience.

Best of luck with whatever you choose.

[Tall_Allen]

There has never been a comparative trial, so you're on your own.

[d3is4me]

Hi If you find any information please post as i am in OZ and paying full price for Zytiga and Apo comes on the free list june 1

[OzzieJ]

I’m on Erleada plus 3 monthly Deapeptyl injections. Didn’t notice any additional side effects to ADT alone. Zytiga was also available but this was the one recommended by my onco. They do a monthly blood check but they mentioned in passing that it was not necessary to do cardiac checks on Erleada (and Ingot the impression that it is on Zytiga?)

[HopingForTheBest1]

It is always disconcerting to me when we need to decide which treatment to choose. There is just so much info out there, more often than not being too technical to fully understand. Of course, any treatment may benefit one patient, but not another.

Do we need to flip a coin? We insufficiently informed patients need to make a life or death decision for ourselves? We look to our knowledgeable medical team to do that for us, don't we?

[dhccpa in reply to HopingForTheBest1]

One problem is that many oncologists don't stay on the cutting edge. They stay five or more years in the past.

[HopingForTheBest1 in reply to dhccpa]

All the more reason for each of us to be our own best advocate, and try our best to read as much as we can so we can ask questions and challenge our medical team. I have done this several times, and was put on at least one long term beneficial treatment with Olapàrib PARP while it was in clinical trials before being FDA approved. At the time my oncologist was unaware of the treatment. I told him all about it, and was glad I did.

[dhccpa in reply to HopingForTheBest1]

Yes, you're right. I was meeting with my RO a month ago. I have never had radiation, but he runs scans for me. He was unfamiliar with triplet therapy being SOC now, and he had never heard of Nubeqa. My MO was, however.

[Derf4223]

If its mostly a matter of cost, zytiga wins massively. I started on Zytiga using a "specialty" pharmacy (SP) that my co-pay ran over $3K the first month and was going to be dropping to $500 after a total of about $7K was reached. The SP shipped me generic version. A bit of luck and checking around found that there are non-specialty pharmacies that sell generics at cost plus a nominal fee or two. I went with Scriptco which the cost of a 3 month fill (360 each) runs a bit over $200. There is a lot of content on this site about this.

[dhccpa in reply to Derf4223]

Try Mark Cuban's Cost Plus online pharmacy. I thought I saw a monthly supply of generic Zytiga for $35 plus shipping.

[SteveTheJ]

FWIW, started taking Erleada (plus Lupron) in April 2020 with no debilitating side effects. The weakness, fatigue and brain fog are becoming more annoying but Provigil during the day really helps with focus and fatigue. Best of luck!

[TMcgee]

Have no information on Erleada, but I’m wondering if Zytiga was going off patent, and Erleada is simply an effort by the pharma to extend the revenue stream?

Again, I don’t have any info, but it is common for phama to rebrand drugs to extend patent. If that is the case wouldn’t Abiraterone (generic Zytiga) be your drug of choice?

[MateoBeach]

Abiraterone plus low dose prednisone (generic) has the huge cost advantage but requires checking electrolytes esp potassium and blood pressure to see if the pred dose needs to be adjusted. Not really a problem if you are going for the long term. And you may be able to cut the dose down to 250 mg by taking it with a moderate fat breakfast. And many report less adverse SEs with abiraterone. Again that is individual.

One other consideration is the possibility of taking abiraterone plus p without also using Lupron or other LHRH ADT drug. As abiraterone can block all testosterone production by itself. This has been demonstrated in small trials. The key if you wanted to try this would be to monitor testosterone levels and verify that they are “castrate” <50 ng/dL. May be worth a try.

[JamesAtlanta]

I have taken branded Zytiga. Then switched to generic due to insurance company insistence (same excellent results - undetectable PSA). After an ADT holiday, went back on hormone therapy - Orgovyx plus Erleada. Back to undetectable PSA for the last 21 months. All worked fine for me. All were prescribed for me at MD Anderson.

I think both will work well. Hope this helps.

[lincolnj8]

Been on Zytiga for 6 years. It is used with prednisone. Together the prednisone and Zytiga have worked well together for me.

[lincolnj8]

Zytiga worked for me for 6 years now