Breaking through resistance in mCRPC: Enzalutamide analogues as effective anticancer agents for enhanced male survival

To alleviate metastatic castration-resistant prostate cancer (mCRPC), enzalutamide, a non-steroidal antiandrogen, is employed. Following androgen deprivation therapy or anti-androgen treatment, compensatory mechanisms in prostate cancer have been identified, leading to increased expression and function of steroidal receptors. Comparative studies involving individuals with CRPC have demonstrated enzalutamide's superior efficacy compared to its predecessor, bicalutamide. Currently, there are four nonsteroidal antiandrogens approved by the US Food and Drug Administration, with two investigational medications undergoing clinical trials. Enzalutamide effectively slowed prostate cancer growth by preventing nuclear translocation and gene expression that are dependent on the AR, according to preclinical research. Its effectiveness in metastatic hormone-sensitive prostate cancer was supported by clinical trials like ARCHES, which also showed an improvement in radiographic progression-free survival with an acceptable safety profile. Resistance to enzalutamide can occur due to the F786L mutation. Recent research has shown that analogues of enzalutamide can overcome this resistance, enhancing anticancer activity and improving male survival rates. We will explore various enzalutamide analogues, including those with trifluoromethyl, trifluoromethoxy, diarylhydantoin, benzothiazole or benzoxazole, and 1-hydroxy-2,2,2-trifluoro-1-ethyl moieties, primarily used to address the resistance issue. Additionally, we will highlight the structural activity relationships of these analogues, which may enhance their antiproliferative effects and increase male survival rates. Notably, imidazolidine derivatives exhibit the most significant antiproliferative activity.