Management of Anticoagulation in Patients With Prostate Cancer Receiving Enzalutamide

Abstract

Enzalutamide, a novel, oral androgen receptor antagonist used for the treatment of metastatic, castration-resistant prostate cancer, has been shown to improve overall and progression-free survival, prolong time to initiation of chemotherapy, reduce skeletal-related events, and carry a favorable adverse effect profile. Metastatic prostate cancer is a disease of older men, a population with an increased incidence of medical comorbidities warranting anticoagulation. Prostate cancer itself, along with some of its therapies, is also prothrombotic. Enzalutamide interacts with several anticoagulants through various mechanisms, making their concurrent use clinically challenging. As such, complex decisions about anticoagulation in these patients are frequently encountered by treating physicians. In this review, we describe the potential interactions between enzalutamide and various anticoagulants, and suggest management paradigms based on the current body of knowledge for patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves.

Profils d’effets indésirables sous abiratérone et enzalutamide : analyse descriptive des données de la base nationale de pharmacovigilance

“…[54]. Selon une revue de la littérature, l'utilisation d'un anticoagulant oral doit être prudente en cas d'association à l'enzalutamide [55], le RCP de Xtandi ® mentionnant par ailleurs une association déconseillée avec les anticoagulants métabolisés par le CYP 2C9, et si nécessaire, requérant un suivi rapproché de l'INR [9]. Le Thésaurus de l'ANSM est sans information à ce sujet.…”

The Complex Management of Atrial Fibrillation and Cancer in the COVID-19 Era: Drug Interactions, Thromboembolic Risk, and Proarrhythmia

“…Particularly, ribociclib exhibits strong inhibitory effect on CYP3A4 when used at high dose (600 mg/day); thus, concomitant use of apixaban or rivaroxaban should be avoided due to potential risk of severe anticoagulant overexposure [25]. Conversely, concomitant use of apixaban or rivaroxaban and enzalutamide (strong CYP3A4 inducer) should be avoided, considering the expected associated risk of anticoagulant underexposure [26]. Although PK/PD monitoring is not required for DOACs in clinical practice, and no trials support this approach, the aforementioned selected scenarios might be considered to assess the actual need for therapeutic drug monitoring.…”

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“…1 Enzalutamide is used clinically in the treatment of prostate cancer. [1][2][3] It is registered in Australia and is available on the Pharmaceutical Benefits Scheme for a limited number of indications. 4 Men with prostate cancer are typically older, 3 and, as pharmacists, we recognise that this is a patient population that is likely to have additional diagnoses for which medications are prescribed.…”

“…[1][2][3] It is registered in Australia and is available on the Pharmaceutical Benefits Scheme for a limited number of indications. 4 Men with prostate cancer are typically older, 3 and, as pharmacists, we recognise that this is a patient population that is likely to have additional diagnoses for which medications are prescribed. In the PREVAIL study, 1 median patient age was 72 years, and 20.2% of patients had a documented history of cardiovascular disease at the time of enrolment.…”

“…A recent review by Shatzel et al 3 provides some timely recommendations regarding the management of anticoagulation in patients receiving enzalutamide. Importantly, they outline the potential for enzalutamide therapy to both increase and decrease drug exposure depending on the drug involved and its pharmacokinetic properties.…”