Enzalutamide for the treatment of non-metastatic prostate cancer

For men with non-metastatic prostate cancer that progresses despite the use of hormone blockers, watchful waiting is the usual option. Treatment with hormone blockers is continued.

What was enzalutamide compared with?

In 2020, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) last looked into the advantages and disadvantages of additional treatment with enzalutamide compared to watchful waiting alone. One relevant study involving 1,401 patients was made available to IQWiG. All participants continued using hormone blockers and following the "watchful waiting" approach. 933 of them also received enzalutamide.

What are the advantages of enzalutamide?

Life expectancy: The study suggests that enzalutamide can increase life expectancy. After about 3.5 years, 31 out of 100 men who had treatment with enzalutamide had died, compared to 38 out of 100 men who did not have treatment with enzalutamide.

Severe diseases of the kidneys and the urinary tract: The study suggests that enzalutamide can delay severe diseases of the kidneys and the urinary tract. About 9 out of 100 men who had treatment with enzalutamide developed this kind of disease, compared to about 10 out of 100 men who did not have treatment with enzalutamide.

What are the disadvantages of enzalutamide?

High blood pressure: The results suggest that high blood pressure is more common in men who take enzalutamide. This side effect occurred in about 6 out of 100 men who took enzalutamide, compared to about 2 out of 100 men who did not.

Severe general problems: Problems such as exhaustion, physical weakness and edemas were more common in men who had treatment with enzalutamide. They occurred in about 8 out of 100 men who took enzalutamide, compared to about 2 out of 100 men who did not.

Severe disorders of the nervous system: The results suggest that problems like dizziness, loss of consciousness and headaches are more common in men who take enzalutamide. They occurred in about 7 out of 100 men who took enzalutamide, compared to about 2 out of 100 men who did not.

Psychiatric disorders: Disorders such as anxiety, depression and sleep problems were also more common in men who took enzalutamide: About 16 out of 100 men who took enzalutamide were affected, compared to about 6 out of 100 men who did not.

No differences

There was also no difference between the treatment groups in terms of the following:

  • Occurrence of severe pain
  • Disabling effects of pain
  • General health
  • Severe side effects overall
  • Treatments stopped due to side effects
  • Quality of life
Labels: C61, Enzalutamide, Xtandi