What is enzalutamide (Xtandi®)?

Enzalutamide is a new type of hormone therapy for men whose prostate cancer has spread to other parts of the body (advanced prostate cancer) and has stopped responding to other hormone therapy treatments. It may help some men to live longer. It can also help control symptoms.

What other treatments are available?

Who can have enzalutamide?

After chemotherapy

Enzalutamide is suitable for men with advanced prostate cancer that has stopped responding to other hormone therapy and chemotherapy treatments.

The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) have approved enzalutamide for men who have already had the chemotherapy drug docetaxel. This means enzalutamide should be available for these men on the NHS.

But if you've already had abiraterone as well as chemotherapy, you may not be able to have enzalutamide.

  • In England, you won’t be able to have enzalutamide if you’ve already had abiraterone – unless you had to stop taking abiraterone within three months because of severe side effects or because your cancer continued to grow.
  • In Scotland, the SMC has approved the use of enzalutamide for men who have already had abiraterone – but not all hospitals are giving it to these men, as they don’t have to follow the SMC guidance.
  • In Wales and Northern Ireland, enzalutamide may not be available for men who have already had abiraterone.

Early research has shown that enzalutamide may only have a small effect in men who have previously had abiraterone. But we need more research into this.

Ask your doctor if it’s better to have abiraterone or enzalutamide as the next treatment after chemotherapy. Speak to your doctor or nurse about whether enzalutamide is suitable for you. You can also talk things through with our Specialist Nurses.

Read more about getting new treatments.

Before chemotherapy

Enzalutamide is also suitable for men who have stopped responding to hormone therapy but haven’t yet had chemotherapy.

If you live in England, Wales, Scotland or Northern Ireland, you should be able to have enzalutamide before chemotherapy.

 

How does enzalutamide treat prostate cancer?

Enzalutamide works by stopping the hormone testosterone reaching the prostate cancer cells. Without testosterone, the cancer cells can’t grow, wherever they are in the body.

In a recent clinical trial, men who had enzalutamide lived about four months longer than men who were given a placebo. A placebo is a dummy treatment, for example, a sugar pill.

What does treatment involve?

Enzalutamide is taken as four tablets, once a day. You should take the tablets at the same time each day.

What are the side effects?

Like all treatments, enzalutamide can cause side effects, including:

  • fatigue (extreme tiredness)
  • loose and watery bowel movements (diarrhoea)
  • hot flushes
  • bone pain
  • headaches.

There is also a small risk of having a seizure (fit). This is rare, and may be more likely if you have other health problems that make you more likely to have a seizure. Enzalutamide may not be suitable for you if you’ve had seizures, a stroke or injury to your brain in the past, or if the cancer has spread to your brain.

What happens next?

Your doctor will monitor your health with blood tests. They will also check how you are feeling, and if you are having any side effects.

For more information on enzalutamide, speak to your doctor or nurse, or call our Specialist Nurses.

If you are having problems getting treatments that your doctor thinks are suitable for you, please let us know.

References

Updated: March 2016

  • List of references  

    • Brasso K, Thomsen FB, Schrader AJ, Schmid SC, Lorente D, Retz M, et al. Enzalutamide Antitumour Activity Against Metastatic Castration-resistant Prostate Cancer Previously Treated with Docetaxel and Abiraterone: A Multicentre Analysis. Eur Urol [Internet]. 2014 Aug
    • Cabot RC, Harris NL, Rosenberg ES, Shepard J-AO, Cort AM, Ebeling SH, et al. Increased Survival with Enzalutamide in Prostate Cancer after Chemotherapy. N Engl J Med. 2012 Sep 27;367(13):1187–97.
    • National Institute for Health and Care Excellence. Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen. Technology appraisal guidance 316. July 2014.
    • National Institute for Health and Care Excellence. Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Technology appraisal guidance 377. January 2016.
    • Northern Ireland Department of Health, Social Services and Public Safety. Endorsed Technology Appraisals 2015/2016. Accessed February 2016.
    • Schrader AJ, Boegemann M, Ohlmann C-H, Schnoeller TJ, Krabbe L-M, Hajili T, et al. Enzalutamide in castration-resistant prostate cancer patients progressing after docetaxel and abiraterone. Eur Urol. 2014 Jan;65(1):30–6.
    • Scottish Medicines Consortium. Treatment of adult men with metastatic castration-resistant prostate cancer (mCRPC) who are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy in whom chemotherapy is not yet clinically indicated. SMC No. 1066/15. March 2016.
    • Scottish Medicines Consortium. Treatment of adult men with metastatic castration-resistant prostate
      cancer (mCRPC) whose disease has progressed on or after docetaxel therapy. SMC No. 911/13. October 2013.
    • Sternberg CN, Bono JS de, Chi KN, Fizazi K, Mulders P, Cerbone L, et al. Improved outcomes in elderly patients with metastatic castration-resistant prostate cancer treated with the androgen receptor inhibitor enzalutamide: results from the phase III AFFIRM trial. Ann Oncol. 2014 Feb 1;25(2):429–34.
    • Thomson D. National Cancer Drugs Fund list Ver2.1 [Internet]. Chemotherapy Clinical Reference Group; 2014. Available from: http://www.england.nhs.uk/wp-content/uploads/2014/10/ncdf-list-10141.pdf