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Prostate cancer cells are dependent on intratumoral androgens for survival, growth, and proliferation.1 For this reason, treatments that reduce the effects of androgens on the prostate, such as enzalutamide and leuprolide, are commonly used to treat prostate cancer and slow disease progression.1 Serum free testosterone and prostate-specific antigen (PSA) are often monitored to determine the effectiveness of such treatment.1,2 Enzalutamide is a pure androgen receptor signalling inhibitor that is effective for the treatment of metastatic castration-resistant prostate cancer (MCRPC).3,4 Enzalutamide is a major substrate of hepatic cytochrome P450 2C8 and 3A4 isozymes (CYP2C8 and CYP3A4), and is commonly subject to pharmacokinetic interactions, which could reduce its effectiveness by changing levels of the drug or active metabolites.5-7 Loss of enzalutamide effectiveness could be indicated by a resultant increase in PSA. Because one goal of treating MCRPC is to reduce serum free testosterone to castrate levels, it is also not in the patient’s best interest to use products that increase testosterone levels. To the authors’ knowledge, there have been no case reports documenting interactions among enzalutamide, leuprolide, and complementary and alternative medications (CAMs). CAMs are commonly used by patients with cancer and are often perceived to be free from adverse reactions or interactions, a perception that contributes to lack of disclosure of CAM use to health care professionals.6,8,9 The lack of disclosure can minimize investigation of adverse effects or interactions associated with CAM use, ultimately endangering patient health. This case report documents outcomes of concurrent use of CAMs, enzalutamide, and leuprolide in a patient with MCRPC.

canadian journal of hospital pharmacy/the canadian journal of hospital pharmacy

Identifying Drug Interactions between Enzalutamide and Complementary Alternative Medications in a Patient with Metastatic Prostate Cancer: A Case Report