Low-Dose Enzalutamide in Late-Elderly Patients (≥ 75 Years Old) Presenting With Metastatic Castration-Resistant Prostate Cancer

Vinh-Hung, Vincent; Natchagandé, Gilles; Joachim, Clarisse; Gorobets, Olena; Dramé, Moustapha; Bougas, Stefanos; Folefac, Edmund; Nguyen, Nam P.; Verschraegen, Claire F.; Yin, Ming

doi:10.1016/j.clgc.2020.03.019

Cited by 21 publications

(16 citation statements)

References 33 publications

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“…The efficacy of enzalutamide might be impaired by reducing the initial dose, even though the PSA-PFS was not statistically different in this study, possibly because of the limited number of patients and events. Vinh-Hung et al reported a retrospective study investigating the efficacy of low-dose enzalutamide in patients aged �75 years with metastatic CRPC and concluded that PSA response and PSA-PFS were not significantly different between the low dose and the standard dose groups PLOS ONE [12]. However, this retrospective study was limited in that 55 patients were stratified to 16 low dose and 43 standard dose groups.…”

Section: Plos Onementioning

confidence: 93%

“…A retrospective study of Japanese patients with CRPC reported that age >75 years was positively associated, and a lower initial dose of enzalutamide was negatively associated, with the occurrence of AEs [11]. Another retrospective study reported that efficacy of low-dose enzalutamide in terms of prostate specific antigen (PSA) response and PSA progression-free survival (PFS) was not statistically inferior to that of the standard dose in patients with metastatic CRPC aged �75 years [12]. However, significant biases should exist regarding patient background between the patients with the low and standard initial doses in both retrospective studies, and the influence of initial dose reduction on efficacy and safety remain to be well elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Initial dose reduction of enzalutamide does not decrease the incidence of adverse events in castration-resistant prostate cancer

et al. 2021

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Background There was no clear evidence whether the initial dose of enzalutamide affects the incidence of adverse events (AEs), and oncological outcome in patients with castration-resistant prostate cancer (CRPC). Methods The clinical charts of 233 patients with CRPC treated with enzalutamide were reviewed retrospectively. After 1:3 propensity score matching (PSM), 124 patients were divided into a reduced dose group and a standard dose group, and the prostate specific antigen (PSA) response and the incidence of AEs were compared. Results 190 patients with CRPC initiated with standard dose enzalutamide were younger and better performance status compared with 43 patients beginning with reduced dose. After PSM, the baseline characteristics were not different between the standard and the reduced dose group. In the PSM cohort, the PSA response rate was significantly lower in the reduced dose group than in the standard dose group (-66.3% and -87.4%, p = 0.02). The incidence rates of AEs were not statistically different between the groups (22.6% and 34.4%, respectively, p = 0.24). Conclusion Initiating treatment with a reduced dose of enzalutamide did not significantly decrease the incidence rate of AEs, and it showed poorer PSA response rate. There is no clear rationale for treating with a reduced initial dose of enzalutamide to reduce the incidence of AEs.

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Section: Plos Onementioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Initial dose reduction of enzalutamide does not decrease the incidence of adverse events in castration-resistant prostate cancer

et al. 2021

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“…Furthermore median PFS was 11.2 months versus 11.9 months ( p value 0.612) for patients receiving low dose and the standard dose respectively. The authors concluded that low-dose enzalutamide in elderly, symptomatic, poor-PS patients with metastatic disease was associated with the high response rate and survival compared to standard dose [18].…”

Section: Discussionmentioning

confidence: 99%

Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report

et al. 2021

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We report a case of an elderly patient with metastatic castration-resistant prostate cancer, initially treated with abiraterone acetate (1,000 mg/day) combined with LH-RH antagonist, prednisone (10 mg/day), and zoledronic acid to manage bone metastases. In consideration of his poor performance status, radiological and biochemical progression of the disease, we decided to switch abiraterone to enzalutamide (160 mg/day). Due to adverse events, we reduced enzalutamide to a dose of 80 mg/day. Currently, the disease is under control despite the use of a low dose of enzalutamide.

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“…Natchagande et al reported another case of an 87-year-old patient treated with 40 mg enzalutamide who showed a good response without relevant toxicity[ 11 ]. Furthermore, a recent Caribbean retrospective chart review suggested that an enzalutamide dose ≤ 80 mg qd ( n = 16) leads to comparable responses in elderly patients with metastatic prostate cancer as compared to patients on 160 mg qd ( n = 43)[ 12 ]. In neither studies plasma trough levels of enzalutamide and its metabolite NDME were measured.…”

Section: Discussionmentioning

confidence: 99%

Deep and ongoing response of castrate-resistant prostate cancer on very low-dose enzalutamide in an elderly chemotherapy–naïve patient: a case report

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Havenith

Erp

et al. 2021

Cancer Chemother Pharmacol

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Background Enzalutamide is an orally administered drug that blocks signaling in the androgen receptor with clinical activity in both chemotherapy–naive and post-chemotherapy patients with castrate-resistant prostate cancer (CRPC). Enzalutamide is generally well-tolerated, but dose reductions are nonetheless needed in case of side effects. Case An 82-year-old patient with chemotherapy–naive metastatic castration-resistant prostate cancer was treated with a very low dose of 40 mg enzalutamide once daily. The trough levels of enzalutamide and the active metabolite N-desmethylenzalutamide were 4.5 mg/L and 3.0 mg/L, respectively. This exposure provided a long-term response without any significant side effects. Conclusion Low doses of enzalutamide may be efficacious, while also reducing the risk of side effects. Furthermore, employing a lower dose would reduce healthcare costs and increase access to enzalutamide. Studies exploring the efficacy of lower enzalutamide doses are warranted.

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Low-Dose Enzalutamide in Late-Elderly Patients (≥ 75 Years Old) Presenting With Metastatic Castration-Resistant Prostate Cancer

Cited by 21 publications

References 33 publications

Initial dose reduction of enzalutamide does not decrease the incidence of adverse events in castration-resistant prostate cancer

Initial dose reduction of enzalutamide does not decrease the incidence of adverse events in castration-resistant prostate cancer

Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report

Deep and ongoing response of castrate-resistant prostate cancer on very low-dose enzalutamide in an elderly chemotherapy–naïve patient: a case report

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