Antiandrogen Monotherapy; Used to Treat Patients with Metastatic Prostate Cancer
Antiandrogen monotherapy is an alternative treatment option to androgen-deprivation therapy with castration for metastatic prostate cancer. There are two types of antiandrogen, such as steroidal and non-steroidal (nilutamide, flutamide, and bicalutamide). For metastatic prostate cancer, castration (surgical or pharmacological) is associated with impotence and loss of libido, and may not always be acceptable to the cancer patient. Therefore, antiandrogen monotherapy is potential alternative treatment option for a prostate cancer patient.
Antiandrogens are a class of drugs that help prevent
androgens, such as dihydrotestosterone (DHT) and testosterone, from mediating
their biological effects in the body. They act directly by blocking the
androgen receptors and/or reducing or preventing androgen production. DHT is
primarily a male hormone that is found in male sexual tissues and is
responsible for the increase in male reproductive spermatozoa. In men, excess
DHT is found in the prostate, seminal fluid, epididymis, and in lower urinary
tract. Testosterone, a natural male hormone, is converted into DHT by reaction
with an enzyme called 5-alpha reductase.
Andrographis paniculata wall is one of the most popular
medicinal plants used traditionally for the treatment of array of diseases such
as diabetes, cancer, high blood pressure and more. With the increasing
prevalence of prostate cancer, the demand for antiandrogen monotherapy drugs is
also increasing with a rapid pace. For instance, in 2019, Astellas Pharma Inc.
and Pfizer Inc. received the U.S. Food and Drug Administration (FDA) approval
for XTANDI (enzalutamide) to treat patients with metastatic castration-sensitive
prostate cancer (mCSPC). Antiandrogens are used as combined androgen blockade
with castration.
However, the changing profile of prostate cancer patients has
made antiandrogen monotherapy an attractive alternative therapeutic approach,
offering potential quality-of-life benefits over conventional treatment
modalities. When drugs with different effects are combined, each drug can be
used at its optimal dose, without intolerable side effects. In drug therapy,
monotherapy refers to the use of a single drug to treat a disease or condition.
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