Is there an anti-androgen withdrawal syndrome for enzalutamide?

Abstract:

BACKGROUND:The anti-androgen withdrawal syndrome (AAWS) can be seen in one-third of patients after discontinuation of first-generation non-steroidal anti-androgen therapy. With the introduction of new agents for anti-androgen therapy as well as alternate mechanisms of action, new therapeutic options before and after docetaxel chemotherapy have arisen (Ohlmann et al. in World J Urol 30(4):495-503, 2012). The question regarding the occurrence of an enzalutamide withdrawal syndrome (EWS) has not been evaluated yet. In this study, we assess prostate-specific antigen (PSA) response after discontinuation of enzalutamide. METHODS:In total 31 patients with metastatic castration-resistant prostate cancer (mCRPC) underwent an enzalutamide withdrawal and were evaluated. Data were gathered from 6 centres in Germany. Patients with continuous oral administration of enzalutamide with rising serum PSA levels were evaluated, starting from enzalutamide withdrawal until subsequent therapy was initiated, follow-up ended or death of the patient occurred. Statistical evaluation was performed applying one-sided binomial testing using R-statistical software, version 3.0.1. RESULTS:Mean withdrawal follow-up was 6.5 weeks (range 1-26.1 weeks). None of the 31 patients showed a PSA decline. Mean relative PSA rise over all patients was 73.9 % (range 0.5-440.7 %) with a median of 44.9 %. CONCLUSIONS:If existent, an AAWS is at least very rare for enzalutamide in patients with mCRPC after taxane-based chemotherapy and does not play a clinical role in this setting. This may be attributed to the different pharmacodynamics of enzalutamide. Longer duration of therapy or a longer withdrawal interval may reveal a rare EWS in the future.

journal_name

World J Urol

journal_title

World journal of urology

authors

von Klot CA,Kramer MW,Böker A,Herrmann TR,Peters I,Kuczyk MA,Ligges U,Gschwend JE,Retz M,Schmid SC,Stenzl A,Schwentner C,Todenhöfer T,Stöckle M,Ohlmann CH,Azone I,Mager R,Bartsch G,Haferkamp A,Heidenreich A,Piper

doi

10.1007/s00345-014-1288-3

subject

Has Abstract

pub_date

2014-10-01 00:00:00

pages

1171-6

issue

5

eissn

0724-4983

issn

1433-8726

journal_volume

32

pub_type

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