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Enzalutamide is indicated for the treatment of progressive castration-resistant prostate cancer. Enzalutamide is approved for the treatment of progressive castration-resistant prostate cancer after chemotherapy with docetaxel since 2012: Enzalutamide extended progression-free survival compared with placebo (8.3 vs. 3.0 months) and total survival (18.4 vs. 13.6 months) (Scher et al., 2012). In the PREVAIL trial, a high efficacy of enzalutamide before chemotherapy was also demonstrated in castration-resistant prostate carcinoma: prolonged progression-free survival, thus later necessity of chemotherapy, which was even more successful in the enzalutamide group (Beer et al., 2014). Enzalutamide has also been approved as a treatment option before chemotherapy since 2014.
Enzalutamide inhibits the signal transduction of the androgen receptor: p>
98% plasma protein binding, hepatic metabolism of enzalutamide mainly via CYP2C8, half-life 3–10 days, renal and fecal excretion of the inactive metabolites.
The most common side effects of enzalutamide are hot flushes, diarrhea and headache. Less common are hallucinations, anxiety, cognitive disorders, itching, neutropenia, falls with fractures, hypertension and epilepsy.
Enzalutamide is a potent enzyme inducer, so caution is recommended with many drug groups such as antiepileptic or oral anticoagulation.
160 mg enzalutamide (four 40 mg capsules) p.o. once a day. The addition of prednisolone is possible, but not necessary. Discontinue treatment with progress or intolerance to enzalutamide.
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© Dr. med. Dirk Manski
man...@urologielehrbuch.de