Alternative hormone therapy with enzalutamide also suitable for older men

This study examined enzalutamide (Xtandi) as a treatment option for older men with metastatic castration-resistant prostate cancer. Researchers concluded that enzalutamide is well-tolerated and improves overall survival in older men with advanced prostate cancer.

Hormone therapy is commonly used to treat advanced prostate cancer. By reducing levels of androgens (the male sex hormones such as testosterone), cancer progression can be delayed and survival increased. However, cancer can continue to spread despite standard hormone therapy (also called metastatic castration-resistant prostate cancer). Such patients are typically treated with chemotherapy. However, chemotherapy is often not recommended for older men due to concerns of complications. Alternative hormone therapy, such as enzalutamide, is often recommended in these cases. Since advanced prostate cancer is more common with increasing age, the safety and effectiveness of enzalutamide in older men needs to be fully established.

This trial included 1,717 men with metastatic prostate cancer, not previously treated with chemotherapy. 609 of these men were aged 75 or older. Men were randomly assigned to receive either treatment with enzalutamide or placebo (substance with no effect on the body). All patients were offered chemotherapy if signs of cancer progression were seen.

The treatment benefit of enzalutamide was similar among older (aged 75 years or older) and younger (aged less than 75 years) men. Average survival among older men was significantly longer with enzalutamide treatment (average 32.4 months) compared to placebo (average 25.1 months). Overall, older men receiving enzalutamide were 39% more likely to survive the duration of the study (average follow-up of 1.5 years). Enzalutamide treatment was also associated with a 83% reduced risk of disease progression.

Fatigue, back pain, hot flushes, and high blood pressure were among the most common side effects associated with enzalutamide treatment. The overall rate of side effects was similar between the two age groups studied. However, older men were more likely to experience falls.

Researchers concluded that enzalutamide is a safe and effective treatment option for older men with metastatic castration-resistant prostate cancer.