Darolutamide (Nubeqa) Vs Enzalutamide ( Xtandi)

[Tinkudi]

Are there any studies comparing efficacy and side effect profile of darolutamide Vs enzalutamide when given together with first generation ADT ?

I read that darolutamide does not cross blood brain barrier so may have lesser side effects ?

[Mascouche]

I asked the Perplexity.ai your exact question:

"Are there any studies comparing efficacy and side effect profile of darolutamide Vs enzalutamide when given together with first generation ADT ?"

Here is its answer:

Based on the search results provided, there are no direct head-to-head studies comparing darolutamide and enzalutamide when given together with first-generation androgen deprivation therapy (ADT). However, several network meta-analyses and indirect comparisons provide insights into their relative efficacy and side effect profiles:

Efficacy:

Enzalutamide appears to be slightly more effective than darolutamide in treating castration-resistant prostate cancer (CRPC). In a network meta-analysis, enzalutamide showed better effects on improving progression-free survival (PFS), PSA progression-free survival (PSA-PFS), and metastasis-free survival (MFS) compared to darolutamide.

Side Effect Profile:

Darolutamide generally demonstrates a more favorable side effect profile compared to enzalutamide:

Darolutamide has lower risks for some adverse events, including fatigue, falls, rash, fracture, and seizure.

Enzalutamide had the highest incidence of fatigue and hypertension among all interventions studied.

Darolutamide has significantly lower blood-brain barrier penetration (approximately 46 times lower) than enzalutamide, resulting in fewer central nervous system (CNS) adverse events.

The incidence of seizures was not increased with darolutamide compared to placebo, while enzalutamide showed a slight increase.

Tolerability:

Darolutamide appears to be better tolerated:

Drug discontinuation due to adverse events was lowest with darolutamide, although this difference was not statistically significant.

Previous meta-analyses concluded that darolutamide had the lowest incidence of grade 3+ adverse events and toxicity leading to drug discontinuation compared to other agents.

Administration:

There are some differences in administration:

Enzalutamide is dosed once daily, regardless of food intake.

Darolutamide requires twice-daily dosing, with food.

Darolutamide has the smallest physical tablet size compared to enzalutamide.

It's important to note that these comparisons are based on indirect evidence and network meta-analyses. Direct head-to-head trials comparing darolutamide and enzalutamide when given with first-generation ADT would provide more definitive evidence of their relative efficacy and safety profiles.

[Tinkudi in reply to Mascouche]

Thank you 😊

[dhccpa in reply to Mascouche]

Thanks. Good question by the poster and good answer.

[j-o-h-n]

Helpful hint when taking Nubeqa:

After taking your prescribed amount from the bottle, turn the bottle upside down to remind yourself that you took the meds. Later if you have to take another dose then turn the bottle right side up. If you're confused then let your wife handle it.........after all she's the one who's slowly poisoning you anyway.

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Brilliant Johnny boy, both my wife and I had a crackin laugh 😂 with this one. Monty Python.

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

Well they don't call me Monty Pysson for nutting, ya know.....(btw Thanks)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[32Percenter]

There probably won't be anytime soon. If one company were to fund such a comparison study, they may be spending millions just to prove their competitor's product is better.

[Pinkpeanuts07]

hi my dad took Enzalutamide only - half dose because of his age (92) - to minimise side effects and it worked to shrink the net in his shoulder and extend his quality of life. Alas, the oncologist took him off it when my dad passed out on one occasion fearing that it could affect his heart.

[Tinkudi in reply to Pinkpeanuts07]

Wow. At 92. How long had he taken the enzalutamide for ? Did he take any other treatments too ? What was his diagnosis ??

[Pinkpeanuts07]

hi Tinkudi my dad took Bicalutamide for 7 years; then Enzalutamide for 9 months. Bisophonates for bone and had 2 bouts of radiotherapy for bone pain ( which only worked for 6 months each time) . Darolutamide would have been a better first option and should have started earlier imo. He had a good run in the Bicalutamide- apparently. Once the cancer spread to his shoulder bone, and he could no longer tolerate the Enzalutamide, he was on borrowed time. He was v stubborn and I guess the doctors thought at 85 that he was more likely to die with not from Prostate cancer. He lived with it for nearly 10 years - in the last 2 years there were lots of ups and downs; the last 6 months difficult. If he’d been in his 60s they probably would have given the option to remove prostate; he’d have made 100! I wish all the very best.

[Tinkudi in reply to Pinkpeanuts07]

thank you. Why did they give him bicalutamide first and not the newer ones ?

[Pinkpeanuts07]

Hi T - which newer ones are you referring to ? When dad was diagnosed, they said it was likely slow growing. The Bicalutamide was used and kept his PSA low for 7 years; I think it was used because the prostate cancer was contained within the prostate gland. There may be better drugs now so make sure you get the best one for your or family member. Best