Related Experiment Videos
Nilutamide: possible utility as a second-line hormonal agent
A Desai1, W M Stadler, N J Vogelzang
1Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
Objectives:
To study the ability of nilutamide to induce prostate-specific antigen (PSA) responses in patients with hormone-resistant prostate cancer who had been exposed to prior antiandrogen therapy, because resistance to antiandrogens may be mediated by altered binding to a mutated or overexpressed androgen receptor and because an alternative antiandrogen may overcome such resistance. Nilutamide is a little used antiandrogen that has a chemical structure distinct from that of the other two antiandrogens, flutamide and bicalutamide.
Methods:
Fourteen patients with hormone-resistant prostate cancer were treated with nilutamide 150 mg/day (n = 12) or 300 mg/day (n = 2). Seven had been treated with one prior antiandrogen (all with bicalutamide), five with both bicalutamide and flutamide, and two had received bicalutamide and prior chemotherapy.
Results:
In a retrospective analysis, 7 (50%) of the 14 patients had a greater than 50% decline in their PSA level, and 4 of the 6 patients with bone pain experienced subjective improvement. The median duration of the PSA response was 11 months (range 2 to 28+) with 2 of the 7 patients still experiencing a PSA response. In addition, 3 patients (20%) had brief and minor PSA responses (less than 50%).
Conclusions:
A subset of patients, whose disease progresses with prior antiandrogen therapy, may experience a PSA response to nilutamide. The role of nilutamide in such hormone-resistant patients deserves additional prospective study.
Insights
Nilutamide may induce prostate-specific antigen (PSA) responses in some patients with hormone-resistant prostate cancer previously treated with antiandrogens. This suggests nilutamide could be a valuable option for patients with advanced prostate cancer.
Area of Science:
- Oncology
- Pharmacology
Background:
- Hormone-resistant prostate cancer (HRPC) poses treatment challenges, often involving resistance to standard antiandrogen therapies.
- Resistance mechanisms may include androgen receptor (AR) mutations or overexpression, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of nilutamide in inducing prostate-specific antigen (PSA) responses in HRPC patients pre-exposed to antiandrogens.
- To explore nilutamide's potential to overcome resistance mediated by altered AR binding.
Main Methods:
- Retrospective analysis of 14 HRPC patients treated with nilutamide (150 mg/day or 300 mg/day).
- Patients had prior exposure to bicalutamide, flutamide, or both, with some also receiving chemotherapy.
Main Results:
- 50% (7/14) of patients achieved a PSA decline >50%.
- Median PSA response duration was 11 months; 2 patients maintained response.
- 20% (3/14) showed minor PSA responses; 4/6 patients with bone pain reported subjective improvement.
Conclusions:
- Nilutamide can induce PSA responses in a subset of HRPC patients progressing on prior antiandrogen therapy.
- Nilutamide shows potential as an alternative antiandrogen in managing advanced prostate cancer.
- Further prospective studies are warranted to define nilutamide's role in HRPC treatment.