The safety and efficacy of enzalutamide in the treatment of advanced prostate cancer

Introduction: Enzalutamide - a non-steroidal second-generation antiandrogen - represents an active treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC) in both chemotherapy-naive and docetaxel-pretreated settings, based on the demonstration of improved overall survival over placebo in two large phase III trials. Areas covered: The therapeutic landscape of mCRPC, narrowed to docetaxel until recently, encompasses now several treatments of a different nature (including androgen receptor targeting agents, taxanes, radiometabolic therapy, and immunotherapy), improving considerably the patients prognosis. However, direct comparisons between these agents still lack, raising the question of the optimal sequence of treatment. Expert commentary: We described in detail available data on clinical efficacy and safety of enzalutamide in different clinical settings (chemotherapy-naive and - pretreated mCRPC patients), analyzing patients characteristics, the effects of enzalutamide on major clinical outcomes and its impact on patients quality of life. Finally, we briefly overviewed ongoing clinical trials evaluating potential active combinations, cross-resistance with other compounds, sequential strategies, and possible prognostic or predictive biomarkers.