Xtandi Should Follow Zytiga for Treatment of Castration-resistant Prostate Cancer, Phase 2 Trial Shows

Xtandi Should Follow Zytiga for Treatment of Castration-resistant Prostate Cancer, Phase 2 Trial Shows
More men with castration-resistant prostate cancer saw their prostate cancer antigen (PSA) levels — a marker of the disease — decline when they took Xtandi (enzalutamide) after Zytiga (abiraterone acetate) than did those who took the medications the other way around, according to results from a Phase 2 clinical trial.  In the randomized, crossover trial (NCT02125357), researchers in Canada sought to determine whether there was an optimal sequence for taking these two inhibitors of androgen signaling, which, despite their wide use, hadn't been directly compared against each other in a clinical trial.  The trial showed that when deciding first- and second-line treatment for men with advanced prostate cancers, Zytiga should be offered first, and patients should switch to Xtandi after showing signs of progression on their initial therapy. Findings were published in the study, “Optimal sequencing of enzalutamide and abiraterone acetate plus prednisone in metastatic castration-resistant prostate cancer: a multicentre, randomised, open-label, phase 2, crossover trial,” in The Lancet Oncology.  Metastatic castration-resistant prostate cancer (mCRPC) is cancer that has spread to distant sites and progresses despite the successful suppression of cancer-stimulating male hormones (androgens) such as testosterone.  Men with mCRPC are offered second-line hormone therapies, including Zytiga (marketed by Janssen Biotech) and Xtandi (marketed by Astellas Pharma) that directly target the androgen pathway. The two medicines work against mCRPC in similar ways, and either can be used as a first-line treatment.  The availability of two equally effective therapies gives patients the option to switch if they fail to respond to one or the other medicine. However,
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