Hi. Good news from UK. For metastatic hormone sensitive disease NHS has decided to fund Enzalutamide (xtandi) for those who cant have chemo due to virus. Husband about to start tx next week if bloods come up ok. My question is about drug interactions. Anyone had issues with xtandi and statins, ramipril, lanzoprazole?
Also any interactions with anti depressants,? Not yet on the latter but being considered. Anyone have any experience or knowledge to share? Thanks.
They also approved abiraterone (finally!). There may be an advantage to doing abiraterone before enzaluatmide, at least that's true for mCRPC.
urotoday.com/conference-hig...
thelancet.com/action/showPd...
eu-focus.europeanurology.co...
Both drugs affect liver enzymes, but there are no specific contraindications for the drugs you named. If not enough prednisone is taken to compensate for what is lost, BP can go down with Zytiga.
Thanks. The Guidance from Nice says that they have to first prescribe enza and then abiraterone may be given if intolerant to enza. Its NG161
"Option to give enzalutamide (subject to confirmation) with androgen deprivation therapy for patients with newly diagnosed metastatic disease instead of docetaxel to reduce toxicity and potential for admission • For patients who are intolerant of enzalutamide, give the option of switching treatment to abiraterone " . Its interim guidance, for 3 months in the first instance, but I think it will likely be extended.
Thanks for the links. I think we might have preferred abi first, although Jack has had an MI and I think Abi was slightly more problematic CV wise. Anyhow, we have no choice! I am concerned at any extra fatigue though I must say as he is pretty tired already from the ADT.
Just hoping for the best …. and thanks NHS - at last!
Hi I am in UK not taking Enzalutamide but been on Zytiga now for 2 years.
I also have daily ramipril and statin, I think you will be ok as they would not prescribe without checking if any interaction with current meds. When I commenced Zytiga I had full Check up on meds with oncologist before prescribing. Enzalutamide can make you very tired and exercise is important to help with this not easy while isolating. I go for brisk walk late in the evening to avoid as much contact as I can Using open spaces parks and golf course seems to work!
Thanks for your reply. ABI is only an option if he proves intolerant of Enza - according to the new guidelines. I guess we wait and see. Thanks for the info re lack of apparent issues with interactions. I know fatigue will be an issue sadly, so trying to encourage some more exercise, but its hard when you feel tired and somewhat depressed. Wishing you well on the zytiga - stay safe. Lets hope Boris doesn't end lockdown too soon.
I thought I heard on need that both abi and candid were available instead of Chemo fir now monitored by GP
Hi. I think there has been a bit of misreporting on this - the level of science journalism is often problematic! The Nice interim guidance is NG161 and says explicitly that oncologists should go with enza first off, and that abi can be given as an alternative if patient is intolerant of enza. The reasoning is not made explicit in the guidance but I suspect that its because with enzalutamide it is not necessary to take steroids (as with abi), which in themselves can impair immunity - to a smaller degree than docetaxel obviously, but still an elevated risk for covid. So, since this is their main reason for allowing an alternative, it makes sense (to them) to go the enzalutamide route initially. BW
Thank you for clarifying, I hope all goes well for you. I am ok so far but ABI is starting to show signs of fading so I hope other options will be available soon as lockdown is limiting this/
I've been on Abi for about 2 weeks, paying for it myself as I didn't want to risk chemo. My Onco is going to check whether I can switch to Enza. Not sure about the risks of switching after only a few weeks.
Hi. Yes. We were also close to doing this, but hesitating since ADT seemed to be still working Ok and Jack is still hormone sensitive. PSA 2. Hopefully you can switch. I would have thought it's ok as they are saying you can switch the other way. Anyhow, good luck and let us know how you get on.
I believe most of us take the Xtandi in the evening. There is a definite wave of sleepiness about an hour and a half later, for me. If the movie is good, I'm ok. If it isn't, I doze off so much I can't remember the ending.
Here in the USA I am shocked by the high cost of both of these drugs, abitaterone and enzauatmide. I am just starting my treatment and my oncologist wants to get
Me started on a hormone treatment that includes Xtendi which retails here in the US for over $5500./month. I am on Medicare advantage plan and my insurance carrier denied the request.
What are the alternatives?
2way,
Early Zytiga or early chemo with Docetaxel may be options, or more likely to be approved, in lieu of Xtandi. Discuss it with you doctor.
If you/your oncologist are still hard-over for Xtandi, you could first go on-line and check the Drug Formulary for your current insurance plan and see how they treat Xtandi (and/or Zytiga). It is often listed as a Prior Approval drug, available from their designated Specialty Pharmacy. A Prior Approval Drugs list can often also be found on-line, where things like a prescription Criteria, Request Form, and Rationale for Xtandi approval can be downloaded.
Some insurance formularies require something this for Xtandi prior approval.
Patient must have ONE of the following:
1. Castration-Resistant Prostate Cancer (CRPC)
2. Metastatic Castration-Sensitive Prostate Cancer (mCSPC)
AND ONE of the following for both indications:
1. Patient is receiving gonadotropin-releasing hormone (GnRH)
analog
2. Patient has had a bilateral orchiectomy
AND ALL of the following:
1. NO dual therapy with another androgen receptor inhibitor (see
Appendix 1)
2. Prescriber agrees to advise males with female partners of
reproductive potential to use effective contraception during
treatment and for 3 months after the last dose of Xtandi
If you have gone through this kind of process with your current plan, and think you still should get it approved, you may be able to work with your doctor on an Appeal.
If you have to go through some kind of "donut hole", there are places on-line where that can be explored. If you would like to compare the costs of drug plans for a particular drug, there are places on-line for that too. Most begin at the basic Medicare website, where you can fill-in your necessary drugs, location, etc. and compare plans, coverages, and costs.
The Xtandi website's Patient Support section has contact info, too, for getting assistance and approvals for Xtandi prescriptions. They have done it hundreds of times, and may be able to help you or your doctor cut through some fog or confusion in getting Xtandi approved, or possibly to get Xtandi at a discounted rate.
Good Luck!
Charles
Thanks for all the good info. I am new at all of this and hope my oncologist and her team have a good treatment plan. I get my 2nd monthly hormone shot in two days from my Uralogist. I am not sure of the hormone but will be sure to ask so I know what I am taking. I have an appointment with my Oncologist the end of the month and will see where this journey takes me. Still trying to get over feeling depressed.
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