Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
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.
- Boyer M. The management of prostate cancer. Aust Prescr 1996;19:22-4.
- Bertagna C, De Gery A, Hucher M, Francois JP, Zanirato J. Efficacy of the combination of nilutamide plus orchidectomy in patients with metastatic prostatic cancer. A meta-analysis of seven randomized double-blind trials (1056 patients). Br J Urol 1994;73:396-402.
- Prostate Cancer Trialists' Collaborative Group. Maximum androgen blockade in advanced prostate cancer: an overview of 22 randomised trials with 3283 deaths in 5710 patients. Lancet 1995;346:265-9.