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Treatment Name: Enzalutamide (Xtandi®)

Enzalutamide (Xtandi®) is a Chemotherapy Regimen for Prostate Cancer

How does Enzalutamide work?
Enzalutamide slows the growth of cancer cells and decreases the size of tumor. In prostate cancer, androgens (steroids made naturally by your body in the testes, adrenal glands, and prostate tumors) bind to androgen receptors and cause the cancer cells to grow. Enzalutamide is known as an anti-androgen and it works by blocking androgen receptors so that androgens, such as testosterone, cannot bind to the receptor which prevents it from stimulating the cancer.

Goals of therapy:
Enzalutamide is medication taken by mouth to slow tumor growth and alleviate symptoms. Enzalutamide has been shown to increase survival and improve quality of life, but is not usually given with the goal of cure.

Schedule

  • Usual starting dose: 160 mg (four 40 mg oral capsules) by mouth once daily
  • All four capsules should be taken at the same time and swallowed whole

Enzalutamide is usually taken at home.

Typical duration of therapy is until the medication no longer works or if the patient cannot tolerate the medication.  If you cannot tolerate the medications, talk to your doctor.

Side Effects

In clinical studies the most commonly reported side effects with enzalutamide are shown here. Side effects sometimes have percentage ranges [example: fatigue occurred 16 - 21%] because they differed between clinical studies:

Percentage of patients that discontinued due to unacceptable side effects:  6 - 8%.

Side effect videos Side Effect Videos
Fatigue Fatigue ConstipationConstipationNausea and VomitingNausea and VomitingDiarrheaDiarrheaPainPain

Monitoring

How often is monitoring needed?  
Your doctor may monitor your blood electrolytes using a Comprehensive Metabolic Panel (CMP) if having diarrhea while taking enzalutamide. If you are taking warfarin (Coumadin®) your doctor may check your INR more frequently.

How often is imaging needed? 
A PET or CT scan may be required before treatment, or at intervals determined by your doctor.

How might blood test results/imaging affect treatment? 
Depending upon the results your doctor may advise to continue this treatment as planned, or delay, or switch therapy

ChemoExperts Tips

  • Patients should be cautious about falling and injuries related to falling. Falls can be caused by fatigue and blood pressure changes caused by this drug
  • Rare instances of seizure have occurred in patients taking enzalutamide. Patients should be made aware of the risk of engaging in activities that may lead to serious injury if a seizure should occur. According to the manufacturer, patients who have a seizure while on enzalutamide should be taken off the medication
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for prostate cancer.  Ask your doctor if any studies are currently enrolling in your area.  If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Enzalutamide (Xtandi®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Enzalutamide (Xtandi®). Depending upon your income, they may be able to help cover the cost of:

  • Enzalutamide

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Enzalutamide (Xtandi®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Enzalutamide (Xtandi®)

Individual Drug Label Information

Enzalutamide (Xtandi®)

  • Enzalutamide is an oral capsule
  • Enzalutamide should be taken once a day. It may be taken with or without food and should be swallowed whole
  • If you miss a dose take the dose as soon as you remember. If you forget the dose for a whole day, just take your regular daily dose
  • Enzalutamide should be stored in a dry place at room temperature
  • Dosage adjustments may be required if side effects are not tolerated or you show signs of toxicity
  • May interact with some medications known as CYP2C8 inhibitors (ex: gemfibrozil), CYP2C9 inducers, CYP2CP substrates (ex: phenytoin, warfarin), CYP3A4 inhibitors, CYP3A4 inducers, CYP2C19 substrates (ex: omeprazole)
  • May interact with some herbal medications such as St. John’s Wort (an herbal product)
General Enzalutamide (Xtandi) Side Effects 
  • Fatigue
  • Back pain
  • Constipation
  • Joint pain
  • Hot flash/flush
  • Decreased appetite
  • Diarrhea
  • Muscle/skeletal pain
  • High blood pressure
  • Weakness
  • Weight loss
  • Peripheral edema
  • Headache
  • Altered taste
  • Seizures (rare)
  • Click on the enzalutamide (Xtandi) package insert below for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPain

See DailyMed package insert.

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References

1. Beer TM, Armstrong AJ, et al. Enzalutamide in Metastatic Prostate Cancer before Chemotherapy. N Engl J Med. 2014;371:424-443.

2. Scher HI, Fizazi K, et al. Increased Survival with Enzalutamide in Prostate Cancer after Chemotherapy. N Engl J Med. 2012;367:1187-1197.

Created: September 8, 2015 Updated: August 30, 2016

What is Prostate Cancer?

A disease of the cells found in the prostate gland in men.  Prostate cancer is a common condition caused by abnormal growth and rate changes in the prostate gland cells that form tumors.  The stage of prostate cancer can vary at diagnosis and throughout treatment.  The staging includes both the TNM + Grade, which is based on exam of tissue removed by surgery, and clinical staging: Stage I, IIa, IIb, III, IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium