Enzalutamide
Clinical data | |
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Trade names | Xtandi |
Other names | MDV-3100; ASP-9785 |
AHFS/Drugs.com | Monograph |
MedlinePlus | a612033 |
License data |
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Pregnancy category |
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Routes of administration | By mouth[2][3] |
Drug class | Nonsteroidal antiandrogen |
ATC code | |
Legal status | |
Legal status | |
Pharmacokinetic data | |
Bioavailability | Rats: 89.7%[6] Humans: unknown (but at least 84.6% based on recovery from excretion)[7][3] |
Protein binding | Enzalutamide: 97–98% (primarily to albumin)[2] NDME: 95%[2] |
Metabolism | Liver (primarily CYP2C8 and CYP3A4)[2] |
Metabolites | • NDME (active)[2][3] • Carboxylic acid derivative metabolite (inactive)[3] |
Elimination half-life | Enzalutamide: 5.8 days (range 2.8–10.2 days)[2] NDME: 7.8–8.6 days[2] |
Excretion | Urine: 71.0%[3] Bile: 13.6%[3] Feces: 0.39%[3] |
Identifiers | |
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Enzalutamide, sold under the brand name Xtandi, is a
Enzalutamide was first described in 2006, and was introduced for the treatment of prostate cancer in 2012.[10][11][12] It was the first second-generation NSAA to be introduced.[13] It is on the World Health Organization's List of Essential Medicines.[14]
Medical uses
Enzalutamide is
Prostate cancer
There is good evidence that enzalutamide is an effective treatment for increasing overall survival among people with high-risk non-metastatic castration-resistant prostate cancer, particularly those with a PSA doubling time ≤ 6 months.[15]
Other uses
Enzalutamide can be used as an antiandrogen in
Available forms
Enzalutamide is provided as a capsule or tablet.[2]
Contraindications
Enzalutamide is
Side effects
Notable
Central adverse effects
Seizures have occurred in approximately 1% of patients treated with enzalutamide in clinical trials.
Rare adverse reactions
There is a single case report of posterior reversible encephalopathy syndrome (PRES) with enzalutamide treatment.[32] The mechanism of action of the side effect is unknown, but it was proposed to a consequence of inhibition of the GABAA receptor by enzalutamide.[32]
Overdose
Enzalutamide may cause
Interactions
Enzalutamide is a moderate to strong inducer of multiple cytochrome P450 enzymes including CYP3A4, CYP2C9, and CYP2C19 and hence has a high potential for clinically relevant drug interactions.[2] Circulating concentrations of enzalutamide may be altered by inhibitors and inducers of CYP2C8 and CYP3A4, and should be avoided if possible.[33]
In a clinical study of enzalutamide for ER -positive breast cancer in women, enzalutamide was found to decrease serum concentrations of the aromatase inhibitors anastrozole and exemestane by 90% and 50%, respectively, which could reduce their effectiveness.[34]
Pharmacology
Pharmacodynamics
Enzalutamide acts as a
When LNCaP cells (a prostate cancer cell line) engineered to express elevated levels of AR (as found in patients with advanced prostate cancer) were treated with enzalutamide, the expression of androgen-dependent genes PSA and TMPRSS2 was down regulated in contrast to bicalutamide where the expression was upregulated.[35] In VCaP cells which over-express the AR, enzalutamide induced apoptosis whereas bicalutamide did not.[35] Furthermore, enzalutamide behaves as an antagonist of the W741C mutant AR in contrast to bicalutamide which behaves as a pure agonist when bound to the W741C mutant.[35]
Dose-ranging studies of enzalutamide in men with prostate cancer have been performed.[31]
Changes in hormone levels
Enzalutamide monotherapy at a dosage of 160 mg/day has been found to increase circulating levels of testosterone by 114.3%, dihydrotestosterone (DHT) by 51.7%, estradiol by 71.7%, sex hormone-binding globulin (SHBG) by 100.6%, dehydroepiandrosterone (DHEA) by 9.6%, androstenedione by 51.1%, luteinizing hormone (LH) by 184.7%, follicle-stimulating hormone (FSH) by 47.0%, and prolactin by 16.8%.[23][37] These changes in hormone levels are similar to those with high-dose bicalutamide monotherapy.[23][37] The median maximum decrease in levels of prostate-specific antigen (PSA) levels was 99.6%.[23]
Comparison with other antiandrogens
Enzalutamide has approximately 8-fold higher
Resistance mechanisms in prostate cancer
Enzalutamide is only effective for a certain period of time, after that the growth of the cancer is not inhibited by this antiandrogen. The mechanisms of resistance to Enzalutamide are being intensively studied.[43] Currently, several mechanisms have been found:
- AR mutations[44][45]
- AR splice variants[46]
- Glucocorticoid receptor bypass[47]
- Increase in flux of glycolysis[48]
- Autophagy mediated resistance[49]
- Wnt signaling activation[50]
- Increase in intra-tumoral androgen biosynthesis mediated by AKR1C3 enzyme[51]
- Interleukin 6 signaling mediated resistance[52]
Cytochrome P450 modulation
Enzalutamide is reported to be a strong inducer of the enzyme CYP3A4 and a moderate inducer of CYP2C9 and CYP2C19, and can affect the circulating concentrations of drugs that are metabolized by these enzymes.[53][33]
Pharmacokinetics
The
Chemistry
Enzalutamide is a
History
Enzalutamide was discovered by
In July 2018, the FDA approved enzalutamide for the treatment of people with castration-resistant prostate cancer.[61] The approval broadens the indication to include people with both non-metastatic castration-resistant prostate cancer and metastatic castration-resistant prostate cancer.[61] Enzalutamide was previously approved for the treatment of people with metastatic castration-resistant prostate cancer.[61]
In December 2019, the FDA approved enzalutamide for the treatment of people with metastatic castration-sensitive prostate cancer (mCSPC).[9] Enzalutamide was previously approved for the treatment of people with castration-resistant prostate cancer.[9]
In June 2023, the FDA approved talazoparib, in combination with enzalutamide, for the treatment of people with homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer (mCRPC).[62]
In November 2023, the FDA approved enzalutamide for the treatment of people with non-metastatic castration-sensitive prostate cancer with biochemical recurrence at high risk for metastasis (high-risk BCR).[63] Efficacy was evaluated in EMBARK (NCT02319837), a randomized, controlled clinical trial of 1068 patients with nmCSPC with high-risk BCR.[63] All patients had prior definitive therapy with radical prostatectomy and/or radiotherapy with curative intent, had PSA doubling time ≤ 9 months, and were not candidates for salvage radiotherapy at enrollment.[63] Patients were randomized 1:1:1 to receive blinded enzalutamide 160 mg once daily plus leuprolide, open-label single- agent enzalutamide 160 mg once daily, or blinded placebo once daily plus leuprolide.[63] The application was granted priority review and fast track designations.[63]
Research
Breast cancer
Research suggests that enzalutamide may be effective in the treatment of certain types of breast cancer in women.[64][65] It has been tested for the treatment of triple-negative, AR-positive breast cancer in a phase II clinical trial.[66][67]
Hirsutism
Enzalutamide has been suggested as a potential treatment for hirsutism and hyperandrogenism in women with polycystic ovary syndrome.[68][69]
References
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- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab "Xtandi- enzalutamide capsule; Xtandi- enzalutamide tablet". DailyMed. 20 November 2023. Retrieved 9 March 2024.
- ^ PMID 25917876.
- ^ "Prescription medicines: registration of new chemical entities in Australia, 2014". Therapeutic Goods Administration (TGA). 21 June 2022. Archived from the original on 10 April 2023. Retrieved 10 April 2023.
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- ^ "Medivation's MDV3100 Shown to Be Effective in a Preclinical Model of Hormone-Refractory Prostate Cancer" (Press release). Medivation, Inc. 26 February 2007. Archived from the original on 16 September 2007. Retrieved 10 May 2009.
- ^ a b c "FDA approves enzalutamide for metastatic castration-sensitive prostate cancer". U.S. Food and Drug Administration (FDA). 17 December 2019. Archived from the original on 22 December 2019. Retrieved 21 December 2019. This article incorporates text from this source, which is in the public domain.
- ^ a b Sawyers, C., Jung, M., Chen, C., Ouk, S., Welsbie, D., Tran, C., ... & Yoo, D. (2006). U.S. Patent Application No. 11/433,829. https://www.google.com/patents/US20070004753 Archived 5 October 2016 at the Wayback Machine
- ^ "FDA approves new treatment for a type of late stage prostate cancer" (Press release). U.S. Food and Drug Administration (FDA). 31 August 2012. Archived from the original on 2 October 2013. Retrieved 16 December 2019.
- ^ Anna Azvolinsky (4 September 2012). "FDA Approves Enzalutamide (Xtandi) for Late-Stage Prostate Cancer". CancerNetwork. Archived from the original on 13 September 2012. Retrieved 6 September 2012.
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Non-steroidal selective androgen receptor antagonists, developed as a treatment for androgen-sensitive prostate cancer, are occasionally used in transgender females who do not achieve their desired results or do not tolerate alternative drugs [52]. There are isolated reports of successful outcomes with flutamide (Eulexin), though reportedly not as effective as cyproterone acetate in reducing testosterone levels [12]. Both flutamide and bicalutamide (Casodex), in conjunction with oral contraceptive pills, have shown significant improvements in hirsutism in natal females with polycystic ovarian syndrome (PCOS) [53, 54, 55, 56, 57]. The use of these agents as antiandrogens in transgender patients has been limited by concerns of hepatotoxicity. However, at low doses, these agents have shown to be both well tolerated and effective when used for the treatment of hirsutism [57]. [...] Table 8.2: Antiandrogens: [...] Androgen receptor blocker: [...] Type: Enzalutamide. Route: Oral. Dose: 160 mg/day.
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- ^ "FDA approves talazoparib with enzalutamide for HRR gene-mutated metastatic castration-resistant prostate cancer". U.S. Food and Drug Administration. 20 June 2023. Retrieved 9 March 2024. This article incorporates text from this source, which is in the public domain.
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