Enzalutamide (XTANDI)

Prostate cancer, non-metastatic castration-resistant

Prostate cancer, metastatic castration-sensitive

Prostate cancer, metastatic castration-resistant

Prostate cancer, non-metastatic castration-resistant

• Dose – Oral: 160 mg once daily continuously until disease progression or unacceptable toxicity
• Given in combination with androgen deprivation therapy (ADT)

Prostate cancer, metastatic castration-sensitive

• Dose – Oral: 160 mg once daily continuously until disease progression or unacceptable toxicity
• Given in combination with androgen deprivation therapy (ADT)

Prostate cancer, metastatic castration-resistant

• Dose – Oral: 160 mg once daily continuously until disease progression or unacceptable toxicity

Available as 40 mg liquid-filled capsules. Capsules contain sorbitol. Capsules should NOT be opened. Store at room temperature.

Antiandrogen

Take with or without food

If a dose is missed, patients should be instructed not to take the missed dose but to resume with the next scheduled dose.

Common: Fatigue.

Less Common: Neuropsychiatric events (seizures, memory impairment, hallucnations), Hypertension, QT prolongation.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, sodium, potassium, blood pressure, ECG (for patients at risk for electrolyte abnormality and QTc prolongation).

During treatment: PSA, blood pressure.

If clinically indicated: creatinine, sodium, potassium, ECG.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Seizures have been reported with enzalutamide. Advise patients of the risk of seizures during enzalutamide treatment and of the risk of engaging in activities where sudden loss of consciousness could cause serious harm to themselves or others.

BC Cancer. BC Cancer Drug Manual. Enzalutamide. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Enzalutamide_monograph.pdf. Updated October 1, 2023. Accessed January 22, 2024.

Lexicomp. Enzalutamide Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/3886703?cesid=9oNjtDY1Dgi&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Denzalutamide%26t%3Dname%26acs%3Dtrue%26acq%3DPenza. Updated January 29, 2024. Accessed January 30, 2024.

Cancer Care Ontario. Enzalutamide Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44321. Updated December 2023. Accessed January 22, 2024.

Astellas Pharma Canada Inc. XTANDI® Product Monograph. Markham, Ontario. Updated January 24, 2022.