Summary

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• This summary is based on the review of 48 systematic review(s)/meta-analysis(es). ^[1-48]
• Metastasis-Free Survival (MFS): Enzalutamide combined with androgen deprivation therapy (ADT) significantly improved MFS in non-metastatic castration-resistant prostate cancer (nmCRPC) compared to ADT alone and outperformed other hormone-based strategies.
• Overall Survival (OS): Enzalutamide + ADT showed the greatest OS benefit among hormone-based strategies; however, no significant differences in OS were observed between enzalutamide and other androgen receptor inhibitors (ARIs) like apalutamide and darolutamide in metastatic castration-resistant prostate cancer (mCRPC).
• Progression-Free Survival (PFS): Enzalutamide demonstrated high efficacy in enhancing PFS versus placebo in nmCRPC and showed favorable PFS outcomes compared to docetaxel and abiraterone.
• Prostate-Specific Antigen (PSA) Progression-Free Survival: Enzalutamide was effective in improving PSA-PFS in both metastatic and non-metastatic settings, highlighting its broad utility in managing prostate cancer.
• Enzalutamide is associated with an increased risk of grade ≥3 atrial fibrillation and hypertension, as well as a higher incidence of fatigue and significant neuropsychiatric effects, including dizziness and mental impairment, compared to other androgen receptor inhibitors (ARIs) like darolutamide.
• In terms of serious adverse events, enzalutamide has a comparable risk of grade ≥3 adverse events to other ARI therapies and is generally well-tolerated; however, it shows a higher risk for hypertension and atrial fibrillation compared to abiraterone.
• Elderly patients (>75 years) experienced a higher incidence of neuropsychiatric side effects with enzalutamide, necessitating careful monitoring, particularly in those with preexisting cardiovascular conditions.
• Enzalutamide demonstrated significant benefits in overall survival (OS) and progression-free survival (PFS) for both high-volume and low-volume metastatic hormone-sensitive prostate cancer (mHSPC) patients, with elderly patients (>75 years) experiencing improved long-term health-related quality of life (HRQoL); however, increased cardiovascular risks necessitate vigilant monitoring in patients with preexisting cardiovascular conditions.