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Therapy Update for Metastatic Castration-Resistant Prostate Cancer

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OBJECTIVE: To provide an overview of the efficacy, tolerability, drug interactions, dosing, and administration issues associated with enzalutamide, abiraterone, and radium-223 for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC).

DATA SOURCES: MEDLINE and Web of Science were used to search for relevant articles using a key-word search (enzalutamide, abiraterone, radium-223, and phase 3). No restriction was placed on the date of publication.

STUDY SELECTION/DATA EXTRACTION: Located articles were reviewed and selected based on their relevance to the treatment of mCRPC. Articles were selected if they focused on double-blind, randomized controlled, phase 3 studies conducted in humans and published in English. Other resources were used for the information pertaining to the drug's mechanism of action, administration, drug interactions, and adverse effects.

Data extraction for the clinical application (e.g., efficacy, adverse reactions, and monitoring) was obtained from the identified clinical trials and the drug's approved labeling by one of the authors and validated by a second author.

DATA SUMMARY: Abiraterone, enzalutamide, and radium-223 have been shown to improve radiographic progression-free survival and overall survival before or after treatment with docetaxel. Abiraterone and enzalutamide has been able to delay time to the initiation of docetaxel. Major adverse effects vary with these medications. Enzalutamide-based therapy was associated with increased risk of seizures. Abiraterone-based therapy was associated with increased mineralocorticoid excess. Radium-223-based therapy was associated with increased risk of myelosuppression.

CONCLUSION: In clinical trials, abiraterone, enzalutamide, and radium-223 improved the radiographic progression-free survival and overall survival in patients with mCRPC compared with placebo. Each drug has unique adverse effects requiring monitoring of routine laboratory tests and for severe associated symptoms. To better define the role of these drugs in the treatment of mCRPC, clinical trials designed to directly compare these drugs' survival rate is necessary.
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Keywords: ABIRATERONE; CASTRATION-RESISTANT PROSTATE CANCER; ENZALUTAMIDE; MCRPC; METASTATIC; RADIUM-223

Document Type: Review Article

Affiliations: Washington State University College of Pharmacy, Spokane, Washington, USA

Publication date: 01 October 2016

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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