Enzalutamide prolongs life for people with prostate cancer

N Engl J Med2012; doi:10.1056/NEJMoa1207506

Prostate cancer may start to grow again after chemotherapy, despite serum levels of testosterone that are as low as after castration. When this happens androgen receptors have become over-expressed and treatment options are limited. Enzalutamide, a new drug that acts in several places on the androgen receptor signalling pathway, seems to prolong survival in these patients.

Of the 1199 such men involved in the phase III trial, two thirds received 160 mg enzalutamide daily while the rest took placebo. The trial was stopped early, after 520 men had died, because a pre-planned analysis showed the drug’s superiority over placebo.

Median survival with enzalutamide was 18.4 months (95% CI 17.3 to not yet reached), whereas with placebo this was 13.6 months (11.3 to 15.8).⇑ All the secondary outcomes also favoured the drug. These included the proportion of men in whom levels of prostate specific antigen (PSA) at least halved during the study (54% with enzalutamide v 2% with placebo), quality of life, and time to progression of the disease accompanied by a predefined rise in PSA (8.3 months v 3.0 months).

More common with the drug were adverse events such as fatigue (34% v 29%), diarrhoea (21% v 18%), and headache (12% v 6%), but also seizure, which was seen in five patients allocated enzalutamide compared with none of those taking placebo.

An enzyme jab may resolve vitreomacular adhesions

N Engl J Med2012;367:606-15OpenUrlCrossRefMedline

The vitreous body of the eye is normally attached to the retina, particularly at the macula, but these ties weaken and break with age, and visual acuity may become impaired. This is called vitreomacular traction, and it can lead to the formation of macular holes, where the macula is distorted and oedematous. In some patients, an epiretinal membrane can form, …