Nilutamide

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Anandron (Hoechst Marion Roussel)
150 mg tablets

Indication: prostate cancer
Antiandrogens can be used in the treatment of prostrate cancer, particularly for metastatic disease. They can reduce the 'flare' of the disease which may occur when a patient starts treatment with a luteinising hormone releasing hormone (LHRH) agonist.1

Flutamide has been available for several years for use in previously untreated patients with metastatic prostate cancer in combination with a LHRH agonist. Nilutamide, another non-steroidal antiandrogen, has been approved for the same indication. In addition, nilutamide has also been approved for treatment in conjunction with surgical castration.

A company meta-analysis2 reviewed1056 patients given nilutamide or a placebo after orchidectomy. Complete or partial regression of the disease occurred in 50% of the treatment group and33% of the placebo group. There were also significant differences in bone pain and the odds of disease progression. There was no significant improvement in survival. This accords with other studies which show that maximum androgen blockade does not result in longer survival than castration.3

Patients commence treatment when they have their orchidectomy or start taking a LHRH agonist. The dose of nilutamide is reduced after 4 weeks, or earlier if adverse effects occur.

The most frequent adverse effect is impaired visual adaptation to darkness. Other adverse reactions include altered liver function, interstitialpneumonitis, nausea and vomiting.