Prostate cancer treatment in Chicago, USA: enzalutamide (Xtandi) fights resistance to hormonal therapy

Resistance to hormone therapy remains a serious threat to patients with malignant prostate tumors – deadly disease affecting 1 million men annually.

Oncologists from Northwestern Memorial Hospital offer an existing drug enzalutamide (Xtandi) to improve prostate cancer treatment in Chicago.

These aggressive tumors became a real problem for oncology, because of lack of effective treatment options. A recent clinical study headed by NMH oncologist Maha Hussain opened up new possibilities for the old drug.

Prostate cancer in facts and figures:

- this disease will kill 1 of 41 men
- about 60% of cases are diagnosed after 65 years
- prostate tumor in men younger than 40 years is extremely rare
- up to 30% of tumors become hormone-resistant after ADT

The results of a three-year placebo-controlled study indicate that enzalutamide treatment reduces the risk of cancer spread and death by 71%. All patients were diagnosed with resistant to hormone therapy tumors.

Towards better prostate cancer treatment

With natural aging process prostate cells accumulate genetic defects giving rise to malignant tumors and other atypical tissues.

The exact cause of disease is unknown, but the patient age is a key risk factor. Oncologists recall such factors as family history, unhealthy diet (especially saturated fats), obesity, toxins in the workplace. Men after 50 are at a higher risk.

According to Dr. Hussein, about three decades ago there were no opportunities for early diagnosis and effective treatment of resistant prostate cancer.

Three decades ago, older men just came to the doctor with back pain, urination problems… Cancer was difficult to diagnose. It was almost impossible to treat. Enzalutamide is an innovative drug for oral administration that blocks male sex hormones. Xtandi deprives the tumor of “fuel” for growth. Its effectiveness is especially high if treatment is prescribed at an early stage of disease.

It is a joint project of pharmaceutical giants Astellas and Pfizer, who financed the recent clinical study. Read details in a paper now published in NEJM.

The study involved about 1,400 men aged 50-95 years. The US Food and Drug Administration is reviewing approval of Xtandi for new category of patients.

About Northwest Memorial Hospital: cancer center #1 in Chicago

NMH is a world-famous medical center located in the heart of Chicago. It is recognized as one of the best cancer centers in Illinois and #16 in the United States. The teaching hospital of Feinberg Medical School (NU).

It was founded in 1972, by merging of Chicago's two oldest hospitals. New institution continued the history of its legendary predecessors helping people with compassion, cutting-edge technologies and professionalism.

The Northwest Medicine has successfully conducted thousands of clinical studies in different areas: cancer, genetic diseases, immunology, rheumatology, heart diseases, transplantology, neurodegenerative diseases, obesity treatment, diabetes, etc.

NMH scientists present several dozen unique inventions and discoveries every year, introducing into clinical practice new medicines and diagnostic services.

Over the past year, hospital received more than 10,000 new cancer patients. Here you can always get professional advice, innovative cancer treatment and rehabilitation. Any diagnosis. Any stage of disease.

Working closely with Robert Lurie Comprehensive Cancer Center, the hospital achieved impressive success and gained national recognition in oncology.

For the six consecutive year, NMH cancer care program is ranked #1 in Chicago.



NMH offers a full range of modern treatment options, including surgical removal of tumors, cryosurgery, targeted radiation therapy and brachytherapy, molecular diagnostics and experimental drugs (such as Xtandi).

Prostate cancer treatment in Chicago: new opportunities

Experienced urologists and oncologists of Northwestern Medicine are the leading American experts in prostate cancer, tumors of the bladder, kidney, testicle and penis. These diseases are widespread, which makes early diagnosis and screening efforts extremely important for maintaining men`s health. At any age.

Prostate cancer is the cause of death #2 among all tumors in men. The treatment tactics depends a lot on the stage. An experienced urologist can recommend you watchful waiting, medications, radiation therapy or immediate removal.

Tumors of the reproductive system in men always require a multidisciplinary approach. It means close collaboration of experts from different areas: radiation and medical oncologist, urologist, surgeon, psychologist, physical therapist, etc.

Treatment options for prostate cancer in Northwestern Medicine:

Surgical removal of tumor

The procedure allows patients to completely get rid of the tumor at an early stage, until malignant cells have not spread beyond the gland.

Radical prostatectomy. The complete removal of the gland and surrounding tissues, including seminal vesicles. This procedure is performed using the open approach (retropubic or perineal prostatectomy) or laparoscopically.

Specially trained NMH surgeons have mastered robotic-assisted prostatectomy using da Vinci® Surgical System.

The use of robotic arms significantly improves accuracy, limits blood loss and accelerates recovery after surgery.

Cryosurgery, sometimes also called cryoablation. Using extremely low temperature, surgeon freezes and destroys malignant cells in the prostate and adjacent tissues.

Radiation therapy of prostate cancer

Targeted energy is widely used in cancer treatment:

- stereotactic radiosurgery (SRS), also known as gamma knife
- intensity modulated radiotherapy (IMRT)
- brachytherapy, or internal radiation
- radium-223 therapy
- proton therapy

Experienced radiation oncologists will choose the optimal therapeutic option for individual needs of each patient.

Chemotherapy and hormone therapy

Hormone therapy (androgen deprivation therapy, ADT) is used to reduce the level of male sex hormones or limit their impact on malignant prostate cells. Testosterone and dihydrotestosterone can stimulate tumor growth, so therapy should slow the progression of disease. But ADT alone will not cure cancer.



Chemotherapy kills prostate tumor cells, disrupting their division and growth. Chemotherapy drugs are injected into the bloodstream, so this method is extremely useful in advanced stages of cancer with metastases. Chemotherapy is not considered the main treatment at an early stage, but some experts recommend short chemotherapy cycles after surgery. According to recent studies, chemo in combination with hormone therapy may be effective.

Immunotherapy

Northwestern Medicine is known for innovative therapies, such as personalized immunotherapy. Among others, Sipuleucel-T cell therapy is offered here. This method works by reprogramming immune cells to search for and destroy tumors. Sipuleucel-T is prescribed for the treatment of metastatic hormone-resistant prostate cancer, when other options have proved ineffective.

Palliative treatment

Treatment of urological tumors changes the life: erectile dysfunction, infertility, problems with urination and defecation, toxic effects of ADT and chemotherapy. Every day you will be surrounded by a team of highly qualified specialists.

They will take care of the quality of life, alleviate your pain and control your symptoms. You will never be alone in the fight against cancer.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator