Enzalutamide at half strength?

[Jim53]

I have high volume mrpca and have had triplit therapy with enzalutamide at 160 mg per day. My response has been great with PCA falling from 700 at diagnosis to undetectable at 3 measurements over the last 6 months. About a month ago I had a serious episode of confusion necessitating a trip to the ER by ambulance and a prolongued stay in the ER until family from out of town could pick me up. My GU oncologist in a university advanced prostate cancer clinic believes the cause of this episode was the CNS effects of enzalutamide and has reduced my daily dose to 80 mg. Any advice as to whether this may harm my progression to mrpca? Shouls I move to full strength abiratarone or darolutamide therapy instead? Thanks for any advice.

[Tall_Allen]

Good questions. Nubeqa (darolutamide) may not cause as much confusion, and it is approved for triplet therapy.

[Echotango51]

My MO at MUSC told me he had patients that responded will with 80 mg a day. I was taking 160 mg for 3 months and had to stop because of bad headaches and blood pressure issues. I’m now back on 160mg a day, 2 in the morning and 2 at bedtime haven’t had any issues. Been on this since August of last year. Good Luck

[Heilung18-Gesund in reply to Echotango51]

I agree. I am also a pt at MUSC and have done well with 80mg qd.

[Stoneartist]

I didnt have any serious side effects, but in reading about Xtandi I wondered about the dosage, thinking that when PSA is down to undetectable then we wouldnt need the full dose. So I have been experimenting - and have concluded that dropping to 120, and then to 80mg dose made no difference to the rate of decline of PSA. So I am on 80mg - and very happy for that.

[CharlieBC in reply to Stoneartist]

I am taking this route also. Once my PSA was beat down to .2, I went to 120 mg per day, now on 80 per day, with a PSA test next week. So far, so good.

[Justfor_ in reply to CharlieBC]

This makes three of us in the adaptable effective dosage camp.

[tocinovino in reply to Justfor_]

Make it 4 to this group.

[Stoneartist in reply to CharlieBC]

Hope it works for you also - the drop in the fatigue side effect was noticeable - and we can ramp up the dosage if the psa starts rising.

[Survivor86]

Jim—Concurrent with SBRT for metastases to my upper spine and right femur, my MO put me on a 24 month course of Lupron and 160 mg. Xtandi (enzalutamide). Within two months my PSA was <.02 However, I did not tolerate SE’s of Xtandi well ( hot flashes, sluggishness and often feeling “foggy”) so after 6 mos on Xtandi my MO switched me to Nubeqa (darolutamide) which apparently does not affect your brain as enzalutamide can . I continued on Lupron/Nubeqa for the next 18 mos., had a lot more energy, fewer hot flashes and the “foggy” feeling was gone. I’ve been on “holiday” now from any drugs for 6 months and am happy to say my PSA remains <.02.

[EdBar]

I have been on enzalutamide for almost 9 years now. After about 5 years side effects became worse, fatigue became extreme, cognitive issues became worse, headaches, BP issue, I really didn’t feel right at all. My MO, doctor Sartor recommended I go to a half dose of 80 mg. Side effects improved, I remained undetectable until about a year ago when PSA started rising on an US PSA test. I recall asking Sartor if I should increase the dose of enzi and he told me no, don’t beat yourself up with it.

I have since had a PSMA scan which detected a highly suspicious activity on a rib which I had radiated and my very low PSA has declined on my last two tests. I continue taking the 80 mg dose.

Ed

[Shamrock46]

My husband was started on 4 Xtandi/day but didn't last long due to SEs including brain fog, fluid retention around his heart that caused breathing problems and 2-night stay in hospital on IV diuretics...then cut to 2/day. SEs kept coming but not as severe until last Fall when he had trouble moving/lifting arms/legs, increased anxiety, severe restless leg syndrome...cut to 1/day. PSA starting rising/doubling and MO convinced him to go back to 2/day 2 mos. ago. Last week he said something was wrong & he didn't feel right, had trouble standing up, legs couldn't support his weight...progressed to having trouble walking, loss of balance, extreme restless leg syndrome that he had never experienced and extreme difficulty going upstairs to bed (which he insisted on). I sent message to MO that he stopped taking it and is off for good! It really scared him...and me! Symptoms lasted but dissipated until he was off for 3 days and are now gone. Bloodwork next wk. and MO in 2 wks. Sorry you're having troubles on it as well.