Has anyone used xtandi as a stand-alone drug. My husband has received very conflicting opinions from 2 urologists...one recommended its use and one said that he couldn't recommend it without the combined use with leuprolide. I know that it has been approved for stand-alone use last year.
His cancer is still castration sensitive. He has previously had a prostatectomy, followed by radiation, and a few years after that 6 months of Lupron (which he doesn't want to repeat). He is currently on no medication but PSA is rising.
Also, if you have been using it as a stand-alone medication, could you please write about the severity of side affects.
Thank you.
Written by
mountain6
To view profiles and participate in discussions please or .
Sounds to me like one Urologist is keeping up with the clinical studies and the other may not be. I believe (of course) Tall Al pointed this out a couple years ago in 2023 (The Embark Phase III Trial) so I believe it has been talked about but wading through search results can be time consuming so here you go:
"enzalutamide monotherapy was also superior to leuprolide alone (hazard ratio for metastasis or death, 0.63; 95% CI, 0.46 to 0.87; P=0.005). No new safety signals were observed, with no substantial between-group differences in quality-of-life measures."
Xtandi (enzalutamide) was approved by the FDA on November 16, 2023 for use as monotherapy in treating non-metastatic castration-sensitive prostate cancer (nmCSPC). This approval is for patients with high-risk biochemical recurrence (BCR).
What is interesting is Nubeqa is also a second generation antiandrogen drug like Xtandi that doesn't cross the blood brain barrier as easy so in general, for most, I believe it has a bit less severe side effect profile (at least in the cognitive realm.) But I don't think it is technically approved yet for non-metastatic castration sensitive. If it were, if I personally had to choose, I would choose Nubeqa monotherapy over Xtandi for the potentially lesser side effects. If their costs are similar, I wonder if a doctor may be able to get away with prescribing Nubeqa "pseudo off label" without the insurance company fussing?
There should be lots of people here that have used Xtandi alone that can give personal accounts of the side effects relative to Lupron. I think a lot of people switch when the Lupron stops working? Not sure if you could go back to Lupron after Xtandi stopped working. Maybe that is the concern of one of the Urologists, that you are going "out of sequence?"
I’ve been on Xtandi monotherapy for about 4,5 months now. As far as I understand it, combining Xtandi with ADT has better outcome in longevity. Monotherapy can bring better QoL but at the cost of being less secure.
I chose monotherapy because I had real problems with ADT, and I’m actually trying to get my doctor to switch me to darolutamide (Nubeqa) monotherapy instead, because of the less severe side effect profile like jazj writes about.
About the side effects from xtandi monotherapy: They are so far pretty manageable. My libido has gone down noticeably and I’ve had to add daily Tamoxifen to stop breast development. I work out pretty hard almost every day to keep the side effects away.
This hit my inbox this week from Urology Times. A very informative summary of the difference between mono therapy and doublet using Lupron adt with Xtandi as shown in the Embarq trials.
I was on mono Xtandi (albeit with Avodart/Finnesteride) from Feb 2014-Nov 2023. Last couple years PSA on slow rise. Chronic and debilitating fatigue and back pain had me go on SS Disability. Currently on Nubeqa and Orgovyx. Side affects for this combo much less than Xtandi and certainly a whole lot better than my prior 3x rounds of Lupron.
I have been on Xtandi for 7+ years as a mono therapy, varying doses as required by psa. My then-oncologist had several years of my response to traditional drugs and on-off periods as his guide and I was comfortable with his prescribing mono for me. It is effective in my case and convenient to order and ingest. The side effects were some breast growth, this after an off period from all drugs. With an onco educated by his past treatments and responses and a willing patient there is limited downside in my opinion. Reversion to traditional drugs is available.
The question for the patient and doctor may be "What is to be gained by this change? Why swap one successful treatment for another?" That should guide the conversation.
My response is not normal and is for anecdotal reference alone.
There are loads of post regarding Xtandi (Enzalutamide) in the H.U. History file. Reviewing them may answer your question(s) regarding your dear Husbands use.
BTW would you please update your Husband's bio. Age? Location? All meds? Treatment center(s)? Doctor's name(s), history? and etc.) All info is voluntary but it will help him/you and helps us too. Thank you!!! Regards to him from all of us.
Maybe consider you should have a medical oncologist. Not a radiation oncologist and not another urologist. When all you have is a hammer pretty soon everything looks like a nail. I didn't see anything in your husband's bio but once the situation is no longer confined to the prostate then you're dealing with a system-wide situation. This is the domain of the medical oncologist. It's not just plumbing anymore. Even if the plumbers are pretty smart.
Ten years in April on Xtandi as mono-therapy. After Proving, refused Lupron any more. Doc now regularly uses Xtandi as mono-therapy with the appropriate men.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
XTANDI worries
Xtandi
Elgie Starting Xtandi
Xofigo+Xtandi beats Xtandi alone for mCRPC
Xtandi and Intermittent 
