Enzalutamide, sold under the brand name Xtandi, is a breakthrough, life-extending medication for castration-resistant prostate cancer.1 Although most nonresected prostate cancers initially respond to chemical or physiological castration, nearly 100% will eventually gain castration resistance, thus falling into the therapeutic niche of enzalutamide. For patients whose cancer is rapidly growing but has not yet metastasized, treatment with enzalutamide has been shown to increase metastasis-free survival times by almost 350%.1 Among patients whose cancer has already metastasized, enzalutamide is associated with a 33% reduction in mortality compared with placebo.2 Enzalutamide represents a particular potential benefit to the developing world, where the burden of prostate cancer is increasing precipitously3 and a greater proportion of cancers are discovered in later stages owing to low screening rates. Unfortunately, the drug is also very expensive. In India, enzalutamide is sold at $65 000 per year, which is half the $130 000 price in the United States, but still represents roughly 40 times the annual income of the average person in India.4
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Friedman J, Gu F, Klausner JD. Pursuing Global Equity in Access to Cancer Drugs: Lessons Learned From the HIV Epidemic. JAMA Oncol. 2019;5(11):1535–1536. doi:10.1001/jamaoncol.2019.3811
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