Bicalutamide in advanced prostate cancer. A review

Area of Science:

• Oncology
• Pharmacology

Background:

• Bicalutamide is a nonsteroidal antiandrogen with a long half-life, allowing once-daily dosing.
• Maximum androgen blockade (MAB) regimens combine antiandrogens with gonadotropin-releasing hormone (GnRH) agonists.

Purpose of the Study:

• To evaluate the efficacy and tolerability of bicalutamide in advanced prostate cancer.
• To compare bicalutamide with flutamide and castration in various treatment settings.

Main Methods:

• A large randomized trial compared bicalutamide 50 mg daily with flutamide 250 mg three times daily in MAB regimens.
• Further trials assessed bicalutamide monotherapy at 50 mg/day and 150 mg/day, comparing it to castration.

Main Results:

• Bicalutamide 50 mg daily in MAB regimens showed a significantly lower rate of treatment failure than flutamide, mainly due to fewer adverse event withdrawals.
• While overall survival differences were not significant, bicalutamide showed longer median times to progression and death.
• Bicalutamide 150 mg/day demonstrated similar survival to castration in non-metastatic disease, with potentially better preservation of sexual interest.

Conclusions:

• Bicalutamide, with its convenient dosing and favorable tolerability, is a valuable option for MAB regimens in advanced prostate cancer.
• The role of bicalutamide as monotherapy is still under investigation.