Het effect van een gereduceerde dosis enzalutamide op bijwerkingen bij kwetsbare patiënten met prostaatkanker

Enzalutamide is a potent androgen receptor signalling inhibitor. Enzalutamide treatment is effective in various stages of prostate cancer. However, the treatment is associated with side effects of the central nervous system like fatigue, cognitive impairment and depression, which can have a large impact on the quality of life. This study investigated whether a reduced dose of enzalutamide (120 mg once daily (OD)) results in fewer side effects compared to the standard dose of enzalutamide (160 mg OD) in frail patients with prostate cancer. Therefore, 52 patients were randomised between both dosages. Patients who were treated with the reduced dose had significantly lower fatigue after 24 weeks compared to those with the standard dose (difference FACIT-Fatigue questionnaire 6.2; 95%-CI 1.4–11.0; p = 0.01). Patients treated with the standard dose experienced increasing fatigue, cognitive side effects and depressive symptoms after 24 weeks of treatment compared to the start of the treatment. In patients with the reduced dose, these symptoms remained stable over time. To conclude, a reduced dose of enzalutamide results in less fatigue, cognitive side effects and depressive symptoms in frail patients with prostate cancer, without any indication of interference with efficacy endpoints.