Enzalutamide helps manage symptoms in advanced prostate cancer

This study examined the effects of enzalutamide (Xtandi) in improving disease-related symptoms associated with advanced metastatic prostate cancer.

The researchers concluded that enzalutamide treatment is effective in managing prostate cancer-derived bone tumors and pain among men with advanced prostate cancer.

When prostate cancer spreads outside of the prostate (also called metastatic prostate cancer), tumors can form in distant parts of the body. The most common site of metastatic prostate cancer is on the bone. Bone tumors can cause significant joint pain, nerve compression, fractures, and necessity for radiation or surgery to the bone (known collectively as skeletal-related events).

New hormonal treatments, such as enzalutamide, are being investigated as options for prostate cancer that has spread to the bone or that has progressed despite standard hormone therapy or chemotherapy. In a large trial, enzalutamide was shown to improve overall survival and cancer progression. However, the effects of enzalutamide in improving skeletal-related symptoms and quality of life has not been fully investigated.

This study included 1,199 men with advanced metastatic prostate cancer that is progressing despite hormone therapy and chemotherapy. Men were randomly assigned to receive either enzalutamide or placebo (a substance with no effect, used as a control). Skeletal-related events and pain severity were compared between the two treatment groups.

Overall, men receiving enzalutamide were 31% less likely to experience a skeletal-related event over the course of treatment than men receiving placebo. 40% of men receiving placebo reported at least one skeletal-related event, compared to 36% of men receiving treatment with enzalutamide. The average time until the first skeletal-related event was also longer with enzalutamide (average 16.7 months) than with placebo (average 13.3 months). The most frequently reported skeletal-related events were radiation to the bone and spinal cord compression, regardless of treatment received.

Enzalutamide significantly improved both pain severity and pain interference with daily life. A progression in pain severity was reported by 28% of men receiving enzalutamide, compared to 39% receiving placebo. Similarly, an improvement in pain severity was more common with enzalutamide (45% of men) than with placebo (7% of men). Quality of life was also significantly improved, and took longer to deteriorate, with enzalutamide treatment. 

The researchers concluded that enzalutamide treatment significantly improved disease-related symptoms, such as skeletal-related events and pain severity, among men with advanced metastatic prostate cancer.