That's likely the case. I was just talking about current situation without data. I would do a sequencing study on Zytiga treated patients if I were MDVN'S/Astellas. It doesn't have to be large or with survival endpoint, rather just PSA and other surrogate endpoints to see Xtandi's efficacy on Zytiga treated.
Based on the two drugs respective MOA, it's hard for me to see Zytiga having any effect at all on Xtandi failures.
The only data I've seen so far on this is from the abstract below. It's certainly by no means definitive but it does suggest there may be modest Zytiga activity following Xtandi. Per the NEJM article 21% of treatment arm in AFFIRM went on to Zytiga, so there may be some exploratory data presented at future ASCO or AUA conference.
In the absence of any prospective sequencing studies yet, how do you see sequencing decisions of X and Z in the mCRPC space shaping up (assuming equal reimbursement) - Z then X based on MOA argument or X then Z based on better efficacy and side effect profile?
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