Study Suggests Enzalutamide (Xtandi) Better and Cheaper Than Abiraterone (Zytiga) for Metastatic, Hormone-Resistant Prostate Cancer.

A recent study presented on May 3-6 at the American Urological Association’s 2019 Meeting found that treating metastatic, hormone-resistant prostate cancer (mCRPC) patients (who had not received chemotherapy) with Xtandi (enzalutamide) leads to better survival outcomes and lower healthcare costs than Zytiga (abiraterone acetate).

While therapies that lower male sex hormones (testosterone) — required for prostate cancer to survive and grow — are a mainstay of therapy for advanced prostate cancer, most patients will eventually acquire resistance to such approaches. This often happens because the cellular receptor for these hormones, called the androgen receptor, becomes constantly active, even in the absence of androgens. Therapies that inhibit the androgen receptor — such as Pfizer and Astellas’ and Xtandi and Janssen’s Zytiga — have largely improved the overall survival of prostate cancer patients, and are now approved for mCRPC patients in the U.S. and Europe. However, which treatment brings the most benefits or the lowest healthcare costs has not been addressed.

In this study, researchers performed a retrospective study to compare the overall survival and healthcare costs associated with these two second-generation androgen receptor inhibitors. They examined data from 3,174 adult men with mCRPC who had not received chemotherapy for at least one year before starting treatment with either Xtandi or Zytiga. Patients had been treated between April 2014 and March 2017, and their data were recovered from the Veterans Health Administration (VHA) database. Overall, 1,945 patients, mean age 73, received Zytiga, while Xtandi was administered to the remaining 1,229 patients, mean age 74.

After examining outcomes of these patients, researchers found that those on Xtandi lived for a median of 30 months, compared to 26 months for Zytiga. This represented a significant 17% reduction in mortality risk with Xtandi. Xtandi-treated patients also required fewer outpatient visits — both overall and cancer-related — than those treated with Zytiga, indicating that Xtandi led to a reduced use of medical resources. In line with this, Xtandi patients had fewer healthcare costs than Zytiga patients. In total, a patient treated with Xtandi would have a monthly healthcare cost of $8,085, compared to $9,092 for Zytiga. Prostate cancer-related costs were also lower for Xtandi — $6,321 versus $7,280.

Thus, researchers concluded that “chemotherapy-naive mCRPC patients treated with Xtandi had better survival, significantly lower resource use and healthcare costs than patients treated with Zytiga.”

The above appeared in the e mail Prostate Cancer News Today, May 16th, 2019.

A Request for Prayer for a Friend.

I have not made such a request before on this website, however a situation has arisen with a good friend. Jim (not his real name) is a 60 years old man with advanced prostate cancer. He has received a number of customary treatment options none of which have curtailed the cancer. He is currently seeking to enroll in a clinical trial of a treatment regimen described earlier on this website. Please pray that if this treatment could be of help to Jim, that he would be accepted into the trial. Please pray for wisdom for his excellent physicians, and that God would extend Jim’s life, provide good quality of life and that God would be glorified in Jim’s treatment and disease. Jim shares his Christian faith openly with other men. Pray also for his family and the support they provide so well.

Presenting Our Imperfect Bodies to a Perfect God

Bryce Canyon, Utah; photo BJ Gabrielsen.

I was raised by wonderful Christian parents who took me to church regularly. I learned about God, Jesus, and well-known Biblical characters such as Noah, Moses, David, Jonah etc. This served as a good moral foundation but at one point, I realized that I knew about God and Jesus intellectually but did not know Him personally. That all changed when I realized that no matter how much of a “nice person” I could be, my good actions would never be enough to match God’s standard of  perfect justice and holiness. It was then that I put my entire faith and trust in the fact that God’s Son, Jesus, had lived a perfect life and then given His life as a sufficient payment to God for all my sins and those of the entire world. At that point in time, I asked Jesus to come into my life, and thereby a personal relationship with God began. My life has never been the same since that day. As an “added bonus”, I was given the extraordinary gift of eternal life according to the famous verse John 3:16. “For God so loved the world, that He gave His only begotten Son (Jesus), that whoever believes in Him, should not perish but have eternal life.”

As the years have passed, I have come to realize that when I yield various aspects of my life to the loving and perfect will of  a personal God and His glory, His best plans for me are a result though they might not always be the plans I had intended. For example, God has blessed my career, given me a wonderful wife, and even a fulfilling retirement. His presence has also been manifested in my health, even though I was diagnosed with early stage prostate cancer in 1995  and now am classified as having advanced prostate cancer though asymptomatic. The major lesson I have learned is that if I yield control of any area of my life to a personal and loving Heavenly Father, His best outcomes in accordance to His will are a result. They may not always be what I would personally choose, and many times life can be difficult, but God’s overwhelming peace and direction transcends every situation. In the words of the Old Testament prophet Jeremiah 29:11-12, “‘ For I know the plans that I have for you’, declares the Lord, ‘plans for welfare and not for calamity to give you a future and a hope. Then you will call upon Me and come and pray to Me, and I will listen to you.”‘

As a cancer patient, areas of my life to which I must daily present and yield control to God are my body, my mind and my overall health. To do that, I have found it very useful to pray the words written by the apostle Paul in the Bible in Romans 12:1-2 and insert my own name in the appropriate text as follows. “I urge you therefore, ——– (insert ones name), by the mercies of God, that you (I) present your (my) body as a living sacrifice, holy and acceptable, which is my reasonable service of worship. And do not be conformed to this world, but be transformed by the renewing of your (my) mind, that you (I) may prove (demonstrate) what the will of God is, that which is good and acceptable and perfect.” While this is not a guarantee of total earthly healing of my disease, who best to control my body than the One who created it in all its masterful complexity. While my cancer has not been healed, I can see God’s protective hand in my disease all these years through His power and often manifested by the excellent medical support which I have received. The ultimate healing will come when I will spend eternity in a new heaven and a new earth with a new body. Meanwhile, as Paul admonishes, I “press on.”

So if you have a personal relationship with God and are dealing with medical issues, I would sincerely suggest that you pray Romans 12:1-2 daily, yielding the direction and outcomes to the Lord. If you are not sure of your relationship with God, see the following link.

 

Website posts may end up in spam.

I am grateful for all of you who subscribe to receive my blogs by email the day after they are posted. However, it has come to my attention that on occasion the Godandprostate blogs end up in spam instead of my inbox. It has happened to me on a few occasions. Therefore, please check your spam folders occasionally to see if this has occurred. Thank you for your continued support.

Radioactive Lutetium-177 Compound Shows Promise As Therapy For Metastatic, Hormone-Resistant Prostate Cancer.

Treatment with the radioactive molecule lutetium-177-PSMA-617 (LuPSMA), which binds to the prostate-specific membrane antigen, is a potential therapeutic strategy for patients with metastatic castration (hormone)-resistant prostate cancer (CRPC), results from a Phase II pilot study suggest.

Prostate-specific membrane antigen (PSMA) is found at high levels in prostate cancers, particularly in patients with hormone-resistant disease — a form of cancer that no longer responds to hormone therapy and continues to progress. More research is assessing the potential of using agents that target this protein to deliver radioactive compounds directly into cancer cells. The LuPSMA molecule is composed of an anti-PSMA antibody bound to the radioactive compound Lutetium-177. Its safety and efficacy are being assessed in a pilot Phase 1/2 study by researchers at the Peter MacCallum Cancer Centre, Melbourne, Australia.

The trial enrolled 50 metastatic CRPC patients whose tumors were positive for the PSMA factor. Their cancer had progressed after standard treatments, including hormone therapy and chemotherapy, and they were offered four doses of LuPSMA, each given six weeks apart. Participants had rapidly progressing disease, taking 2.6 months to double their PSA levels — a marker of prostate cancer. Most patients had received the chemotherapies docetaxel (Taxotere; 84%) and  cabazitaxel (Jevtana; 48%). Hormone therapy with Zytiga (abiraterone), Xtandi (enzalutamide) or a combination of both had been given to 90% of patients.

The study’s primary goals were to measure the number of patients whose PSA levels dropped and the treatment’s toxicity. Additional objectives included imaging responses, time patients lived without disease worsening, overall survival, and quality of life scores.

Investigators reported a reduction in PSA levels by at least 50% in 64% of patients, including 44% who experienced a reduction of at least 80%. Among the 27 patients with measurable disease at the study’s start, 56% experienced a partial or complete tumor reduction. The median time patients lived without disease worsening — measured through a rise in PSA levels — was 6.9 months. Their median overall survival was 13.3 months. A total of 14 patients received additional LuPSMA doses after their disease progressed. In nine of these patients (64%), PSA levels reduced by at least 50%. The most common side effects were dry mouth, nausea, and fatigue. Serious side effects were rare and included abnormally low levels of platelets and anemia, both detected in 10% of cases.

Overall, these early findings confirm the “high response rates and low toxicity with LuPSMA in men who had progressed after standard therapies,” even “in patients who subsequently progressed and were administered further LuPSMA,” the researchers wrote. “These results have provided the basis for randomised controlled trials currently underway,”

These findings were shared in a poster presented at the  2019 Genitourinary Cancers Symposium, Feb. 14–16 in San Francisco.

EPI-7386 Under Development for Metastatic, Hormone-Resistant Prostate Cancer.

EPI-7386 is a new androgen receptor inhibitor, selected as Essa Pharma’s lead candidate therapy for metastatic castration (hormone)-resistant prostate cancer (mCRPC). EPI-7386 works differently from current hormonal therapies by targeting a different region of the androgen receptor: instead of preventing androgens from binding the receptor, EPI-7386 binds to the N-terminal domain needed to activate the androgen receptor signaling cascade. Through this novel mechanism, EPI-7386 is able to block the androgen receptor even in cells that acquired resistance to other androgen receptor inhibitors, like Xtandi (enzalutamide). Essa expects to begin clinical trials for EPI-7386 by April 2020.