Navigating mCRPC Treatment: A Look at Abiraterone and Enzalutamide

Metastatic castration-resistant prostate cancer (mCRPC) is incurable and resistant to many forms of treatment, making it one of the leading causes of cancer-related deaths in men. However, some therapies have proven to be effective in managing mCRPC’s many symptoms.

Chemotherapy and immunotherapy are two common forms of mCRPC treatments, but they may come with a host of unpleasant side effects, including fatigue, nausea, and muscle pain.

Hormonal therapies are another option for those battling mCRPC, and while they don’t come without side effects, they are showing improved results in slowing the progression of certain cancers.

Abiraterone and Enzalutamide as mCRPC Treatments

Two common forms of hormonal therapies used to treat mCRPC are abiraterone and enzalutamide. Used in tandem with prednisone, abiraterone is often utilized as a first-line treatment for patients with mCRPC due to its ability to obstruct the CYP17A enzyme. Enzalutamide, on the other hand, is an androgen receptor inhibitor.

A recent study compared abiraterone and enzalutamide to determine which therapy was more effective in treating mCRPC. The study focused on 5,779 U.S. veterans with mCRPC over the span of eight years.

The study found that patients who began treatment with enzalutamide exhibited better survival outcomes than those who were treated with abiraterone acetate. Over a period of four years, patients treated with enzalutamide lived an average of 0.9 months longer than those treated with abiraterone acetate. The enzalutamide group also displayed a faster response to treatment than the abiraterone acetate group. The benefits of starting treatment with enzalutamide were small, but not statistically insignificant.

Side Effects of Enzalutamide and Abiraterone Acetate for mCRPC

Cancer treatments rarely come without adverse events, and enzalutamide and abiraterone acetate are no exception. Common side effects of enzalutamide include fatigue, diarrhea, headache, and even seizure in rare cases. Abiraterone acetate can cause fatigue, back pain, nausea, constipation, and bone pain.

Managing Side Effects

In order to stave off the negative side effects of enzalutamide and abiraterone acetate, providers should advise patients to pay close attention to any considerable changes in their normal body function when starting treatment.

Gastrointestinal side effects can present after administration of enzalutamide and abiraterone acetate. These negative effects can be combated with antidiarrheal agents and steroid suppositories. Fatigue, which is also common, can be managed by getting a full night’s sleep and exercise.

Physical activity can be difficult when undergoing treatment for mCRPC, but light exercise, including walking and swimming, can aid in keeping the side effects of these therapies at bay. Of course, providers should always be sure to approve any drastic changes to one’s training regimen.

It is also imperative for patients to avoid unhealthy habits like smoking and eating excessive amounts of foods high in sugar and saturated fats. An unhealthy diet may exacerbate side effects and cause additional adverse events.

References:

La, J., Wang, L., & Corrigan, J. (2024, August 16). Abiraterone or enzalutamide for metastatic castration-resistant prostate cancer. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822420

Tonyali, S., Haberal, H. B., & Sogutdelen, E. (2017, October 22). Toxicity, adverse events, and quality of life associated with the treatment of metastatic castration-resistant prostate cancer.Current Urology. https://pmc.ncbi.nlm.nih.gov/articles/PMC5704704/

Michaelson, M. D., Cotter, S. E., Gargollo, P. C., Zietman, A. L., Dahl, D. M., & Smith, M. R. (2008, May). Management of complications of prostate cancer treatment. CA: A Cancer Journal for Clinicians. https://pmc.ncbi.nlm.nih.gov/articles/PMC2900775/

Fatigue and cancer treatment. Fatigue and Cancer Treatment - NCI. (n.d.). https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue#treating-cancer-fatigue