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The current standard of care for patients with metastatic castration resistant prostate cancer (mCRPC) and dis-ease progression is either treatment with abiraterone acetate and prednisone in asymptomatic or mildly symp-tomatic patients without visceral metastases, treatment with enzalutamide or treatment with docetaxel in more symptomatic patients and in the presence of visceral metastases.
Rothemundt et al. previously demonstrated favorable effects of metformin in a phase II trial: it yields objective PSA responses and may induce disease stabilization and improve metabolic endpoints in patients with CRPC. Therefore addition of metformin to enzalutamide might have positive impact on tumor progression, on body composition, and insulin sensitivity.