Video: Tomasz Beer, MD Speaks On Xtandi, Erleada, & Nubeqa | Excerpt from the 2019 PCRI Conference
2019 PCRI Conference | Transcription
Dr. Moyad: So, you published, so there's these three anti-androgens that everybody's going gaga over. Xtandi, Erleada, and Nubeqa, the new one. So there's three out there to choose from and I saw a paper, it was with you, and then I saw a paper with C. Higano that said, you know, they're similar, but they're different, and so you have to have that discussion about which one you might qualify for based on your personality and your profile. I mean now that there's three of these out there, do you just have any comments? But the reason why I bring this up is I went through some of your papers like I always do and you wrote a paper with someone that had the most simple statement, but it was profound, and those are my favorite statements. You said basically, all of these pills that are working, that worked with advanced prostate cancer called castrate-resistant prostate cancer (CRPC) we're now starting to move toward hormone-sensitive prostate cancer. So what people don't realize is, they go, "Well I don't qualify for that drug." But all these drugs that are working miracles are now being brought back to the patient earlier and earlier until one day who knows how early we're going to use them, correct?
Dr. Beer: Right.
Dr. Moyad: So can you say anything about these three drugs that are out there? Any sort of commentary? I mean, where they might be going? Or any sort of other miscellaneous thoughts on them?
Dr. Beer: Sure, so, I mean I think that there is some—there are two ways I think about differences between these drugs. One is inherent differences between the actual drugs and their chemistry and consequently their side effect profile. And then the other is the differences in the evidence that we have that supports their use. So, if you look at enzalutamide, apalutamide, and darolutamide. Enzalutamide has been around the longest, and for full disclosure, I've been very involved with many studies of enzalutamide. So we have the most evidence for enzalutamide in various situations.
Dr. Moyad: The most evidence for Xtandi.
Dr. Beer: Xtandi, yeah.
Darolutamide is the newest kid on the block. What appears to distinguish it is lower side effect profile, which folks are linking to the suspicion that it doesn't penetrate the blood-brain barrier as much which means if you have cancer in the brain, that's not the drug you'd want to choose obviously, but the fatigue and the cognitive dysfunction, the falls, we think, are side effects of the drug on the brain and so for patients for whom that's a major concern darolutamide may have an advantage. But I think we know we need to think about each patient, their particular disease state, do we have evidence to support a particular drug in that situation and what is the side effect profile that we're concerned with and then choose the optimal drug one patient at a time.