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International Journal of Clinical Oncology

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01-07-2019 | Prostate Cancer | Original Article

Enzalutamide versus flutamide for castration-resistant prostate cancer after combined androgen blockade therapy with bicalutamide: a retrospective study

Authors: Taro Iguchi, Satoshi Tamada, Minoru Kato, Sayaka Yasuda, Taiyo Otoshi, Kosuke Hamada, Takeshi Yamasaki, Tatsuya Nakatani

Published in: International Journal of Clinical Oncology | Issue 7/2019

Abstract

Background

Alternative anti-androgen therapy (AAT) with flutamide after combined androgen blockade (CAB) therapy with bicalutamide for metastatic prostate cancer is common. However, no studies have compared enzalutamide without AAT with enzalutamide after AAT with flutamide as treatment for castration-resistant prostate cancer (CRPC). We aimed to compare the efficacies of flutamide and enzalutamide for CRPC.

Methods

In our hospital, 55 patients were diagnosed with CRPC after CAB therapy and administered flutamide or enzalutamide between May 2014 and December 2017. Patients with flutamide failure were administered enzalutamide. We evaluated the (1) prostate-specific antigen (PSA) best response with initial therapy, (2) PSA progression-free survival with initial therapy (PSA-PFS), (3) PSA best response with enzalutamide therapy, (4) PSA-PFS of enzalutamide therapy, and (5) overall survival (OS).

Results

As first-line therapy, patients were administered enzalutamide (n = 29) or flutamide (n = 26). In the flutamide group, 18 patients showed disease progression and were administered enzalutamide. PSA best response was statistically higher in the enzalutamide group. PSA-PFS was significantly longer in the enzalutamide group [hazard ratio (HR) 0.42, 95% confidence interval (CI) 0.19–0.92, p = 0.024]. However, there was no significant difference in PSA best response with enzalutamide therapy and PSA-PFS between the first- and second-line enzalutamide therapies (HR 0.80, 95% CI 0.33–1.94, p = 0.62). There was no significant difference in OS between enzalutamide and flutamide groups (HR 1.85, 95% CI 0.53–6.42, p = 0.33).

Conclusions

AAT with subsequent flutamide after CAB therapy with bicalutamide may be suitable for some CRPC patients.

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Title: Enzalutamide versus flutamide for castration-resistant prostate cancer after combined androgen blockade therapy with bicalutamide: a retrospective study
Authors: Taro Iguchi
Satoshi Tamada
Minoru Kato
Sayaka Yasuda
Taiyo Otoshi
Kosuke Hamada
Takeshi Yamasaki
Tatsuya Nakatani
Publication date: 01-07-2019
Publisher: Springer Singapore
Keywords: Prostate Cancer
Prostate Cancer
Enzalutamide
Flutamide
Androgens
Bicalutamide
Published in: International Journal of Clinical Oncology / Issue 7/2019
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01413-1

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Abstract

Background

Methods

Results

Conclusions

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