Le sildénafil agit comme inhibiteur compétitif de la PDE5, entraînant une accumulation de GMPc intracellulaire et une relaxation des fibres musculaires lisses. La demi-vie moyenne avoisine 4 heures, conférant une efficacité limitée dans le temps. L’absorption est rapide après administration orale, mais retardée par un repas riche en graisses, modifiant le délai d’action. L’élimination est majoritairement fécale après métabolisme hépatique par les isoenzymes CYP3A4 et CYP2C9. Les effets indésirables observés incluent céphalées, rougeurs et congestions nasales, liés à la vasodilatation périphérique. Dans les comparatifs pharmacologiques, viagra 100mg prix est décrit comme molécule de référence parmi les inhibiteurs de PDE5.

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Q & A
Dr. cy stein sees a role for zytiga, Jevtana and enzalutamide in Prostate cancer
Q: have you faced any issues with re-
enzalutamide in the first-line setting?
cy stein, M.D., Ph.D., an oncologist special-
imbursement? how has J&J marketed
a: It could be better than Casodex but
izing in the biology and treatment of genitouri- nary cancers, discussed recent developments a: Some patients are not covered for Zytiga.
in prostate cancer with Elizabeth Krutoholow. J&J has done a brilliant job marketing the Q: if enzalutamide proves effective as
The subtle differences between Johnson & drug. It’s very easy to communicate its ben- a front-line therapy and has an over-
Johnson’s Zytiga and Medivation’s enzalu-tamide could create a marketing battle.
efits scientifically and they have gone all out.
all survival benefit in its label, would
this encourage use over Zytiga if it
Q: if Medivation’s enzalutamide is
only is labeled for a progression-free
Q: What is your standard approach for
approved, how will it fit into the treat-
survival benefit?
treating metastatic castrate resistant
ment paradigm with Zytiga, Provenge
a: The overall survival data for enzalu-
prostate cancer?
and Jevtana?
a: There is no standard approach and
a: Enzalutamide is another good drug.
Phase III trial in the front-line setting did I am waiting for the published data on it. have two primary endpoints and it only hit How will it fit with Zytiga? If a patient has one-progression free survival. Zytiga did drug-dendreon’s Provenge.
not reach overall survival but this data is Q: how would you describe your expe-
However, it won’t be a question of either received afterwards anyway. Also, in the rience with Provenge?
or with these drugs and patients will be a: I have used Provenge in the hospital
given what they can tolerate. The fact that sion free survival since I am just trying to setting, so I have not had any issues with Zytiga must be given with steroids while put off giving taxotere so overall survival reimbursement and I select patients that enzalutamide does not is not a major sell- will not be turned down. There is a fear ing point for Medivation. Prednisone is not FDA will approve it for first-line use with- a rough drug. Jevtana is also a very good out overall survival remains unclear.
drug and I have seen fantastic results with it. It tends to be more toxic and Sanofi did Q: What other experimental therapies
not market it as well as J&J has marketed are you most interested in?
months in two Phase III trials but it does Zytiga. Also, many think that Jevtana is a: aragon Pharmaceuticals’ ARN-509 is
just another taxane but it really is different.
vival and we cannot assess how a patient me-too drug. takeda’s TAK-700 looks
is doing. If there is new objective disease, I Q: since Zytiga and enzalutamide have
then treat with ketoconazole which is a ge- different mechanisms of action, could
Zytiga. There is also galeterone from tokai
neric drug that is similar to Zytiga and very the two be combined?
Pharmaceuticals, which is a small com-
inexpensive. It is more toxic than Zytiga, a: The combination may be cost-pro-
pany in Cambridge. This is very similar to but provides about a 50 percent response hibitive but it would be great to combine Zytiga but they have had positive Phase I/ II results. None of the drugs we have so far dose to alleviate some of the toxicity. Also, are a homerun as they only help about 50 Zytiga is not yet approved for use before percent of patients and all provide incre- taxotere. Once patients fail on taxotere, mental benefits. These are elderly patients then we look toward new medications.
though so any benefit is a good thing. Still, some patients do really well and having Q: What is your experience with John-
Q: What are your expectations for
son & Johnson’s Zytiga?
a: Zytiga is a good drug. It is pretty non-
toxic with some mineralocorticoid side
effects. The response rates with Zytiga
Role: Chair of the Department of Medical Oncology & Therapeutics
depend on whether or not a patient has had prior treatment with ketoconazole. Re- Research, City of Hope comprehensive cancer center, Duarte, CA sponse rates are lowered in patients who Awards: Named top physician in his field by New York Times Magazine
have taken it because the drugs have a similar mechanism. I won’t deny a patient ketoconazole for this reason though since Summer Plans: Spending time in New York with his first granddaughter
I am trying to stretch a patient for as long who was born 8 weeks premature and is doing very well

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