What are the main differences between enzalutamide/enzalutamide (Anacotan) and abiraterone?

Enzalutamide/Enzalutamide and Abiraterone are two targeted drugs commonly used to treat metastatic castration-resistant prostate cancer (mCRPC). Although they are both androgen receptor pathway inhibitors, there are certain differences in their mechanisms of action, usage and therapeutic effects.

First, enzalutamide and abiraterone have different mechanisms of action. Enzalutamide blocks the stimulation of prostate cancer cells by androgens by inhibiting the activity of androgen receptors, thereby inhibiting the proliferation of cancer cells. It is an oral drug that can effectively penetrate the blood-brain barrier, so it can not only inhibit the effects of androgens in the periphery, but also effectively combat possible metastases in the brain. Abiraterone reduces the synthesis of androgens in the body by inhibiting an enzyme called CYP17, thereby reducing the dependence of cancer cells on androgens.

Secondly, the administration methods of the two are also different. Enzalutamide is usually taken orally once daily, while abiraterone needs to be used in combination with prednisone or prednisolone, because while abiraterone inhibits the CYP17 enzyme, it may lead to a decrease in cortisol levels in the body, leading to side effects. Therefore, treatment with abiraterone requires monitoring of hormone levels and is often combined with corticosteroids.

In terms of efficacy, both have proven to be able to prolong patient survival and slow down disease progression, but the choice for clinical use may be determined based on the patient's specific situation, drug tolerance and side effects. Studies have shown that enzalutamide may show better efficacy in patients who are resistant to castration treatment, especially in patients with more severe disease, while abiraterone is mainly used in patients in the early or middle stages of treatment.

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