Xtandi

Treatment with enzalutamide should be initiated and supervised by specialist physicians experienced in the medical treatment of prostate cancer. Posology The recommended dose is 160 mg enzalutamide (four 40 mg soft capsules) as a single oral daily dose.

Medical castration with a luteinising hormone-releasing hormone (LHRH) analogue should be continued during treatment of patients with CRPC or mHSPC who are not surgically castrated. Patients with high-risk BCR nmHSPC may be treated with Xtandi with or without a LHRH analogue.

2 ng/mL) after 36 weeks of therapy. 0 ng/mL for patients who had prior primary radiation therapy. 1). 3 If a patient misses taking Xtandi at the usual time, the prescribed dose should be taken as close as possible to the usual time. If a patient misses a dose for a whole day, treatment should be resumed the following day with the usual daily dose.

If a patient experiences a ≥ Grade 3 toxicity or an intolerable adverse reaction, dosing should be withheld for one week or until symptoms improve to ≤ Grade 2, then resumed at the same or a reduced dose (120 mg or 80 mg) if warranted.

Concomitant use with strong CYP2C8 inhibitors The concomitant use of strong CYP2C8 inhibitors should be avoided if possible. If patients must be co-administered a strong CYP2C8 inhibitor, the dose of enzalutamide should be reduced to 80 mg once daily.

5). 2). Hepatic impairment No dose adjustment is necessary for patients with mild, moderate or severe hepatic impairment (Child-Pugh Class A, B or C, respectively). 2). 2). 4). Paediatric population There is no relevant use of enzalutamide in the paediatric population in the indication of treatment of adult men with CRPC, mHSPC, or high-risk BCR nmHSPC.

Swallowing difficulties/history of dysphagia population Enzalutamide is also available as tablets (40 mg and 80 mg) for patients who have difficulties swallowing large capsules or for patients with a history of dysphagia. Method of administration Xtandi is for oral use.

The soft capsules should not be chewed, dissolved or opened but should be swallowed whole with a sufficient amount of water, and can be taken with or without food.

Summary of the safety profile The most common adverse reactions are asthenia/fatigue, hot flush, hypertension, fractures, fall, and headache. Other important adverse reactions include ischemic heart disease and seizure. 3% in bicalutamide-treated patients.

4). 4). Tabulated list of adverse reactions Adverse reactions observed during clinical studies are listed below by frequency category. Frequency categories are defined as follows: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100); rare (≥ 1/10,000 to < 1/1,000); very rare (< 1/10,000); not known (cannot be estimated from the available data).

Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. 5) Vascular disorders Very common: hot flush, hypertension Gastrointestinal disorders Not known*: dysphagia∞, nausea, vomiting, diarrhoea Hepatobiliary disorders Uncommon: hepatic enzymes increased Skin and subcutaneous tissue disorders Common: dry skin, pruritus Not known*: erythema multiforme, Stevens-Johnson syndrome, rash Musculoskeletal and connective tissue disorders Very common: fractures‡ Not known*: myalgia, muscle spasms, muscular weakness, back pain Reproductive system and breast disorder Common: gynaecomastia, nipple pain#, breast tenderness# General disorders and administration site conditions Very common: asthenia, fatigue Injury, poisoning and procedural complications Very common: fall * Spontaneous reports from post-marketing experience.

¥ As evaluated by narrow SMQs of ‘Convulsions’ including convulsion, grand mal convulsion, complex partial seizures, partial seizures, and status epilepticus. This includes rare cases of seizure with complications leading to death. † As evaluated by narrow SMQs of ‘Myocardial Infarction’ and ‘Other Ischemic Heart Disease’ including the following preferred terms observed in at least two patients in randomized placebo-controlled phase 3 studies: angina pectoris, coronary artery disease, myocardial infarctions, acute myocardial infarction, acute coronary syndrome, angina unstable, myocardial ischaemia, and arteriosclerosis coronary artery.

8). The decision to continue treatment in patients who develop seizures should be taken case by case. 8). PRES is a rare, reversible, neurological disorder which can present with rapidly evolving symptoms including seizure, headache, confusion, blindness, and other visual and neurological disturbances, with or without associated hypertension.

A diagnosis of PRES requires confirmation by brain imaging, preferably magnetic resonance imaging (MRI). Discontinuation of Xtandi in patients who develop PRES is recommended. 4 Second Primary Malignancies Cases of second primary malignancies have been reported in patients treated with enzalutamide in clinical studies.

2%). Patients should be advised to promptly seek the attention of their physician if they notice signs of gastrointestinal bleeding, macroscopic haematuria, or other symptoms such as dysuria or urinary urgency develop during treatment with enzalutamide.

5). A review of concomitant medicinal products should therefore be conducted when initiating enzalutamide treatment. 5) should generally be avoided if their therapeutic effect is of large importance to the patient, and if dose adjustments cannot easily be performed based on monitoring of efficacy or plasma concentrations.

Co-administration with warfarin and coumarin-like anticoagulants should be avoided. 5). Renal impairment Caution is required in patients with severe renal impairment as enzalutamide has not been studied in this patient population. Severe hepatic impairment An increased half-life of enzalutamide has been observed in patients with severe hepatic impairment, possibly related to increased tissue distribution.

The clinical relevance of this observation remains unknown. 5) may be increased. Recent cardiovascular disease The phase 3 studies excluded patients with recent myocardial infarction (in the past 6 months) or unstable angina (in the past 3 months), New York Heart Association Class (NYHA) III or IV heart failure except if Left Ventricular Ejection Fraction (LVEF) ≥ 45%, bradycardia or uncontrolled hypertension.

1. 6).