The FDA has approved Enzalutamide (MDV3100) for treating prostate cancer after chemotherapy has failed putting it in direct competition with Zytiga (Abiraterone Acetate).
What is surprising is the swiftness of this decision, taking only 3 months to complete their review. This is record breaking efficiecy for the FDA and shows how quickly they can respond when needed.
Enzalutamide is second to market and so will have to convince oncologists who are now familiar with Zytiga that it will provide any benefits. It is unlikely that a physician would take a patient off Zytiga who is responding to this treatment, so where does Enzalutamide fit in ?
1. Post Chemotherapy First Option
Enzalutamide could be used as the first therapeutic option post chemotherapy where it has the advantage in not having to be taken with prednisone. The Zytiga prednisone combo can then be used as a back up if the cancer becomes resistant to Enzalutamide.
2. Post Chemotherapy With Zytiga
Enzalutamide could be used alongside Zytiga and there is some evidence this may overcome drug resistance. However this would be a very expensive combination in practise.
3. Post Chemotherapy Post Zytiga
There is currently no evidence that Enzalutamide will work post Zytiga when the cancer has become hormone independent.
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