From the Guidelines
Bicalutamide (Casodex) is used to treat prostate cancer, specifically in patients with non-metastatic or metastatic castration-resistant prostate cancer (CRPC) as a secondary hormonal therapy option.
Indications for Bicalutamide
- Non-metastatic CRPC: Bicalutamide can be considered in patients with non-metastatic CRPC, particularly those with a PSA doubling time ≤10 months, as an alternative to enzalutamide, taking into account the different side-effect profiles and costs of the agents 1.
- Metastatic CRPC: Bicalutamide may be used in patients with metastatic CRPC who have not received prior novel hormone therapy, although enzalutamide is generally preferred due to its superior efficacy in extending progression-free survival (PFS) 1.
- Early hormonal management: Bicalutamide has been studied as an early hormonal management option for androgen-sensitive metastatic, recurrent, or progressive prostate cancer, with some evidence suggesting a reduction in the risk of progression and improvement in progression-free survival, although its use in this setting is not universally recommended 1.
Dosage and Administration
- The typical dosage of bicalutamide is 50 mg/day, although higher doses (e.g., 150 mg/day) have been used in some studies 1.
- Bicalutamide can be administered orally, usually once daily, and may be given in combination with other therapies, such as luteinizing hormone-releasing hormone (LHRH) agonists or androgen deprivation therapy (ADT) 1.
From the FDA Drug Label
Bicalutamide tablets 50 mg is an androgen receptor inhibitor indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analog for the treatment of Stage D2 metastatic carcinoma of the prostate. Bicalutamide tablets are a prescription medicine called an androgen receptor inhibitor, used in combination with luteinizing hormone-releasing hormone (LHRH) medicines to treat Stage D2 metastatic prostate cancer.
Bicalutamide (Casodex) is used for:
- Treatment of Stage D2 metastatic carcinoma of the prostate
- Treatment of Stage D2 metastatic prostate cancer Key points:
- Used in combination with a luteinizing hormone-releasing hormone (LHRH) analog
- Not approved for use alone or with other treatments at a dose of 150 mg daily 2 2 2
From the Research
Uses of Bicalutamide (Casodex)
Bicalutamide, also known as Casodex, is a non-steroidal antiandrogen used in the treatment of prostate cancer. The uses of bicalutamide can be summarized as follows:
- Treatment of locally advanced prostate cancer as immediate therapy either as an adjuvant to active treatment or as monotherapy as an alternative to surgical or medical castration 3, 4, 5
- Treatment of localized or locally advanced prostate cancer to reduce the risk of objective disease progression 6, 7
- Monotherapy in patients with locally advanced disease, offering survival benefits and advantages in terms of maintenance of physical capacity and sexual interest 3, 6, 7
- Combination therapy with a luteinizing hormone-releasing hormone agonist analogue (LHRH-A) for advanced disease, providing equivalent efficacy to flutamide combination regimens with better tolerability 6
Benefits of Bicalutamide
The benefits of bicalutamide include:
- Better tolerability profile compared to castration 3, 6
- Retention of libido and sexual potency when used as monotherapy 6
- Lower incidence of diarrhea compared to flutamide when used in combination with an LHRH-A 6
- Improved health-related quality-of-life scores for sexual interest and physical capacity compared to surgical or medical castration 4, 5