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**BI 836845 + enzalutamide** is a combination therapy under clinical investigation for the treatment of metastatic castration-resistant prostate cancer (mCRPC), especially in patients previously treated with and failed docetaxel and abiraterone. BI 836845 (also known as xentuzumab) is a monoclonal antibody that neutralizes insulin-like growth factors IGF-1 and IGF-2, thereby inhibiting downstream signaling pathways involved in tumor growth and survival. Enzalutamide is an androgen receptor antagonist that blocks androgen receptor signaling, a key driver in prostate cancer progression. The rationale for the combination lies in overcoming resistance to enzalutamide by inhibiting compensatory growth signaling through the IGF pathway[1][5].
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