Introduction
Xtandi, also known by its generic name enzalutamide, is a key drug in the treatment of prostate cancer. Its development marks a significant advancement in how doctors approach this common cancer. Xtandi works differently than older hormonal drugs, and many men now use it to fight their disease.
This guide will tell you about Xtandi. You will learn how it works and its benefits. We will also discuss important considerations for its use. Whether you’ve just received a prescription or are exploring your treatment choices, this article aims to provide clear facts to help you understand this medicine better.
What Is Xtandi?
Xtandi is a pill that blocks male hormones from affecting cancer cells. The FDA first approved it in 2012. Back then, it was only for men with advanced prostate cancer who had already tried chemotherapy.
Dr. Jonathan Simons, a prostate cancer expert, says: “Enzalutamide is a major breakthrough in treating prostate cancer. It blocks the effects of male hormones on cancer cells in multiple ways, making it more effective than older drugs.”
Who Can Take Xtandi Now?
Xtandi is now approved for:
- Metastatic castration-resistant prostate cancer (cancer that has spread and doesn’t respond to hormone therapy)
- Non-metastatic castration-resistant prostate cancer (cancer that doesn’t respond to hormone therapy but hasn’t spread)
- Metastatic castration-sensitive prostate cancer (cancer that has spread but still responds to hormone therapy)
This wider approval means more patients can benefit from Xtandi earlier in their treatment.
How Xtandi Works
Prostate cancer usually grows because of male hormones called androgens, mainly testosterone. Many treatments work by lowering testosterone levels in the body.
Xtandi works differently. Dr. Maria Chen explains: “Enzalutamide blocks androgens in three ways. It stops androgens from attaching to receptors. It prevents these receptors from moving into the cell nucleus. And it keeps the receptors from turning on genes that help cancer grow.”
This three-way approach blocks hormone activity more completely than older treatments. This matters because prostate cancer often becomes resistant to simpler hormone therapies.
How Well Does Xtandi Work?
Several large studies have shown Xtandi’s benefits:
AFFIRM Trial: This study led to Xtandi’s first approval. Men with advanced prostate cancer who had already had chemotherapy lived longer with Xtandi. They survived 18.4 months on average, compared to 13.6 months with a placebo.
PREVAIL Trial: This study looked at men with advanced prostate cancer who hadn’t yet had chemotherapy. Xtandi reduced the risk of death by 29% and slowed cancer growth by 81%.
PROSPER Trial: Men with non-metastatic cancer went longer before their cancer spread when taking Xtandi (36.6 months versus 14.7 months).
ARCHES Trial: When combined with hormone therapy in men whose cancer had spread but still responded to hormones, Xtandi reduced the risk of cancer progression or death by 61%.
Dr. Robert Wilson notes: “Xtandi has shown benefits at different stages of prostate cancer. This suggests it can help throughout the course of the disease.”
How to Take Xtandi
The usual dose is 160 mg (four 40 mg pills) once a day. You can take it with or without food. Try to take it at the same time each day.
If you have mild to moderate liver problems or severe kidney problems, you don’t need to change the dose. But if you have severe liver problems, the recommended dose is 80 mg once a day.
Dr. Samantha Wright advises: “Taking your medicine regularly is very important with Xtandi. Missing doses might make it less effective. Try to develop a routine for taking your pills.”
Side Effects
Like all medicines, Xtandi can cause side effects. Knowing about them helps patients and doctors manage treatment better.
Common Side Effects:
- Feeling tired
- Hot flashes
- Less appetite
- Muscle and bone pain
- High blood pressure
- Headache
- Dizziness
Serious but Less Common Side Effects:
- Seizures (occurs in about 1 in 200 patients)
- Brain swelling (PRES)
- Falls and broken bones
- Heart problems
Dr. Elena Martinez stresses: “While seizures are rare, tell your doctor if you have ever had seizures, brain injury, stroke, or take medicines that might lead to seizures.”
Drug Interactions
Xtandi can interact with other medicines. It can affect how other drugs work, and some drugs can change how well Xtandi works. Important interactions include:
- Drugs processed by CYP3A4, CYP2C9, and CYP2C19 enzymes
- Strong CYP2C8 blockers
- Strong or moderate CYP3A4 inducers
Always give your doctor a complete list of all medicines, supplements, and herbs you take.
Quality of Life
While living longer is a key goal, how well you live during treatment matters too. Studies have looked at how Xtandi affects daily life.
The TERRAIN trial compared Xtandi to another hormone therapy. It found that Xtandi not only slowed cancer growth but also helped maintain quality of life longer. The PREVAIL trial showed similar results.
Dr. James Thompson says: “When we talk to patients about treatment options, we explain that Xtandi usually lets men keep up their daily activities with manageable side effects. But everyone’s experience is different. Your healthcare team should check regularly how treatment is affecting your life.”
Cost and Access
Xtandi is expensive. In the US, the monthly price without insurance can be over $13,000. However, there are programs to help patients get this medicine:
- Medicare and private insurance (though you may still have costs)
- Patient assistance from the maker (Astellas Pharma)
- Co-pay assistance programs
- Foundation support for those who qualify
Dr. Patricia Martinez explains: “New cancer drugs like Xtandi offer important benefits but come at high costs. This raises questions about access that our healthcare system is still working on.”
If you’re worried about paying for Xtandi, talk to your doctor, insurance company, and hospital financial counselors about your options.
Xtandi vs. Other Treatments
Xtandi is one of several treatments for advanced prostate cancer. Understanding how it compares helps patients and doctors make good choices.
Comparison with Zytiga (Abiraterone): Zytiga is another hormone therapy used in similar situations. Key differences include:
- How it works: Zytiga blocks hormone production, while Xtandi blocks hormone effects
- How you take it: Zytiga must be taken on an empty stomach with prednisone (a steroid); Xtandi can be taken with or without food and doesn’t need prednisone
- Side effects differ between the two medicines
Dr. Michael Chen notes: “We don’t have studies directly comparing which drug helps people live longer. The choice between Xtandi and Zytiga often depends on the patient’s specific situation, other health issues, and which side effects they can better tolerate.”
Other Treatment Options: Depending on your cancer stage and past treatments, other options may include:
- Chemotherapy (docetaxel, cabazitaxel)
- Immunotherapy (sipuleucel-T)
- Radiopharmaceuticals (radium-223)
- PARP inhibitors (for certain genetic mutations)
- Newer hormone therapies (darolutamide, apalutamide)
Dr. Sarah Johnson emphasizes: “Treatment is becoming more personalized. The best sequence of therapies depends on your specific cancer, past treatments, other health conditions, and preferences. A team approach with different specialists often helps find the best plan.”
Current Research
Research on Xtandi continues to advance in several areas:
Combination Approaches: Studies are looking at Xtandi combined with:
- PARP inhibitors for patients with DNA repair mutations
- Immunotherapy drugs
- Targeted radiation
Predicting Who Will Benefit: Researchers are working to find markers that might show which patients will respond best to Xtandi.
Earlier Disease Stages: Studies are exploring Xtandi use in even earlier stages of prostate cancer.
Dr. William Nguyen explains: “The field is moving toward more personalized approaches. We’re trying to understand which patients benefit most from Xtandi, when to start it, and how to overcome resistance that eventually develops.”
Practical Advice for Patients
If you’re taking Xtandi, here are some helpful tips:
Managing Side Effects:
- For fatigue: Plan rest periods, stay active as you can, and consider when you take your medicine
- For hot flashes: Layer clothing, avoid triggers like spicy food and alcohol
- To prevent falls: Remove home hazards and consider physical therapy for strength
Monitoring During Treatment: Expect regular check-ups that may include:
- PSA blood tests to check how well treatment is working
- Imaging as needed
- Side effect assessments
- Blood pressure checks
- Lab tests for liver and kidney function
Linda Garcia, a nurse practitioner, advises: “Communication with your healthcare team is essential. Track any new symptoms between appointments, and don’t hesitate to ask questions about managing side effects.”
Frequently Asked Questions
How quickly does Xtandi work? PSA levels (a blood marker for prostate cancer) often begin to drop within weeks. However, response varies between individuals. Your doctor will typically check your PSA after about 4-6 weeks to see how you’re responding.
Can I take Xtandi with food? Yes, you can take Xtandi with or without food. The important thing is taking your daily dose at about the same time each day.
Will Xtandi cure my prostate cancer? Xtandi is not a cure. It’s a treatment that controls cancer, often for long periods, by stopping hormones from fueling cancer growth. The goal is to slow progression and help you live longer with a good quality of life.
How long will I need to take Xtandi? Treatment usually continues until the cancer grows despite the medicine or until side effects become too difficult to manage. For some patients, this may mean years of treatment. Your doctor will regularly check if the benefits outweigh any risks.
Can I drink alcohol while taking Xtandi? There are no specific warnings about alcohol in the Xtandi prescribing information. However, alcohol might worsen side effects like dizziness, fatigue, or risk of falls. It’s best to discuss alcohol use with your doctor.
What should I do if I miss a dose? If you miss a dose, take your normal dose as soon as you remember that same day. If you miss the entire day, just resume your normal schedule the next day. Don’t take extra pills to make up for a missed dose.
Is Xtandi chemotherapy? No, Xtandi is not chemotherapy. It’s a hormone therapy that blocks androgen receptors. Unlike chemotherapy, which attacks rapidly dividing cells throughout the body, Xtandi specifically targets the hormone pathway that drives prostate cancer growth.
Can women handle Xtandi tablets? Pregnant women or women who might become pregnant should not handle Xtandi tablets without gloves. The medicine can be absorbed through skin. Animal studies suggest it may cause problems in male fetuses.
Conclusion
Xtandi has greatly improved prostate cancer treatment. It effectively blocks male hormones from feeding cancer growth in multiple ways. This has helped many patients at different stages of the disease. While side effects, drug interactions, and cost are important to consider, Xtandi offers a valuable option for treating prostate cancer.
As research continues, we’ll learn more about how best to use Xtandi, which patients benefit most, and effective combination strategies. Understanding Xtandi’s benefits and limitations helps patients have better conversations with their doctors about personalized treatment plans.