Xtandi Vs Zytiga

When it comes to comparing Xtandi with Zytiga there is no comparison - Zytiga wins handsdown on performance and price. Zytigas benefits go way beyond overall survival and there is an observable reduction in PSA levels together with a reduction in bone mets. Xtandi still has to stand the test of time in real clinical use and it will be interesting to see how it performs in this respect. Its hard to see how Xtandi will compete with Zytiga especially as it is priced considerably higher. Lets compare the 2 drugs:

Xtandi (Enzalutamide, MDV3100)
Price $7,500 per month
Oral Drug
Dose: 160 mg per day
Overall Survival Benefit: 4.8 months
Drawbacks: Cardiotoxic seizure risk
Advantage: No prednisone required

Zytiga (Abiraterone Acetate, CB7630)
Price $5,000 per month
Oral Drug
Dose: 1000 mg per day
Overall Survival Benefit: 4.6 months
Drawbacks: Prednisone coadministered
Advantage: Good safety profile and proven clinical benefits

The price of Xtandi at $ 7,500 per month is prohibitively expensive for all but the richest men with prostate cancer. The annual cost is $ 89,000 so this is aimed at the Provenge end of the market which costs $ 93,000 per treatment. However Provenge is FDA approved pre chemotherapy while Xtandi is FDA approved post chemotherapy so Xtandi would have to be paid for privately and used off-label to compete with Provenge. Who can afford to pay $ 7,500 per month privately? Not many I would think.

Will the clinicians deem the extra cost of Xtandi worthwile when compared to Zytiga ? Unlikely since this is still an experimental treatment and they may want to see more evidence for its safety.