A case report of enzalutamide administration in a dialysis-dependent patient with castration-resistant prostate cancer

Abstract

Enzalutamide, an androgen receptor signaling inhibitor, is a standard of care treatment for metastatic castration-resistant prostate cancer. We present the first reported case of enzalutamide in a patient with end-stage renal disease, on dialysis. While there were no significant toxicities, a sustained increase in systolic blood pressure was maintained after starting enzalutamide, suggestive of a degree of drug accumulation. Further evaluation of novel hormonal agents in end-stage renal disease patients should be encouraged as this population is typically excluded from clinical trials.

Plasma Levels of Enzalutamide and Its Main Metabolites in a Patient With Metastatic Castration-resistant Prostate Cancer Undergoing Hemodialysis

“…In similar case reports, no significant toxicities were observed. 10,11 Plasma levels were measured at 2 weeks, 1 month, and 2 months after the start of treatment. Although the first sample was taken while plasma concentrations were not yet at steady-state, the enzalutamide concentration was above the suggested target of 5.0 mg/mL.…”

“…Enzalutamide Plasma Concentrations During Hemodialysis treatment without pharmacokinetic assessment. 10,11 We present a case of enzalutamide treatment in a patient with end-stage renal disease undergoing hemodialysis, including plasma levels of enzalutamide, the active metabolite N-desmethyl enzalutamide, and the inactive metabolite enzalutamide carboxylic acid.…”

Metastatic castration-resistant prostate cancer and the challenge of a patient with chronic kidney disease in hemodialysis

“…Concerning enzalutamide, although there is scarce information on the dose adjustments in hemodialysis patients, 7 caution is advised in patients with severe renal impairment. The drug is primarily eliminated by hepatic metabolism, and the renal excretion is insignificant.…”

Renal and Cardiovascular Toxicities by New Systemic Treatments for Prostate Cancer

“…The two main metabolites are the active N-desmethyl enzalutamide and the inactive carboxylic acid metabolite [50,51]. The highest elimination rate of the drug is renal (about 70% of total dose) [52]. Several interactions with drugs metabolized by CYP2C and CYP3A4/5 have been described.…”