Understanding Erleada for Treating Advanced Prostate Cancer

Understanding Erleada as a Treatment for Prostate Cancer

Erleada (apalutamide) has emerged in recent years as an important new treatment option for men with prostate cancer. It belongs to a class of medications known as androgen receptor inhibitors or anti-androgens. While not technically a chemotherapy, Erleada works by blocking the effects of androgens like testosterone on prostate cancer cells, thereby inhibiting their growth.

How Erleada Works

Prostate cancer relies on androgens like testosterone to grow. The cancer cells have proteins called androgen receptors that allow testosterone and other male hormones to bind to them. When testosterone binds to the receptors, it triggers changes in the cells that cause them to multiply and spread.

Erleada is designed to interfere with this process by binding to the androgen receptors before testosterone can. When Erleada occupies the receptors, it blocks testosterone from attaching and activating the receptors. This causes the cancer cells to essentially starve without the stimulating effects of testosterone.

Effectiveness of Erleada

Clinical trials have shown that Erleada can significantly slow prostate cancer progression. In one study of men with prostate cancer that had spread but was still responding to hormone therapy, Erleada was found to extend lives by about 2 years compared to standard hormone treatment alone.

The FDA approved Erleada in 2018 based on this trial. It showed that men who took Erleada went an average of 40 months before their cancer worsened, compared to 16 months with standard care. Erleada also performed better for prolonging survival, with 83% of men still alive after 3 years, versus 77% of men not taking Erleada.

Using Erleada for Prostate Cancer

Erleada is approved to treat prostate cancer in several situations:

• Metastatic castration-sensitive prostate cancer - Erleada treats prostate cancer that has spread to other parts of the body and is still responding to initial hormone therapy.
• Non-metastatic castration-resistant prostate cancer - Erleada can be used for cancers that have stopped responding to hormone treatment but have not yet spread beyond the prostate to distant sites.
• Metastatic castration-resistant prostate cancer - Erleada is also approved for prostate cancer that has spread and is no longer responding to hormone deprivation therapy.

The typical dosage is 240 mg taken as a single oral daily dose. Erleada is generally continued until the cancer progresses or the side effects become too difficult to tolerate.

Side Effects of Erleada

As with most cancer medications, Erleada can cause side effects. Some of the most common include:

• Fatigue
• Joint and muscle pain
• Rash
• Diarrhea
• Nausea
• Weight loss
• Decreased appetite

Erleada also carries a risk of more serious side effects like heart problems, fractures, and seizures. Since Erleada reduces testosterone levels, it can also lead to sexual side effects like erectile dysfunction and reduced fertility.

Monitoring on Erleada Treatment

Doctors will monitor men taking Erleada closely through periodic blood tests and imaging scans to check the medication's effectiveness. They will also watch for any emerging side effects and may adjust the dosage or stop treatment if problems occur.

In addition to cancer monitoring, doctors will watch for impacts on bone health by checking for fractures and bone density loss. Heart health will also be followed periodically with EKGs and blood pressure checks.

Considering Other Treatment Options

If Erleada stops keeping prostate cancer in check after a period of effectiveness, there are other medications and therapies to consider.

Androgen Receptor Inhibitors

Two other drugs similar to Erleada are also approved for treating advanced prostate cancer: Xtandi (enzalutamide) and Nubeqa (darolutamide). These medications work the same way as Erleada by blocking testosterone's effects. If cancer progresses on Erleada, switching to one of these other anti-androgens is an option.

Chemotherapy

Traditional chemotherapy drugs remain an important option after anti-androgen drugs stop working. Docetaxel and cabazitaxel are two common chemotherapies used for prostate cancer. These drugs work by directly killing cancer cells and have been shown to extend survival.

Chemotherapy often causes significant side effects like fatigue, nausea, nerve damage and increased infection risk. However, many men can tolerate treatment for long periods.

Radium-223

Radium-223 (Xofigo) is a targeted radiation drug approved for metastatic castration-resistant prostate cancer. Unlike radiation beams aimed at tumors from outside the body, radium-223 is injected through a vein and travels through the bloodstream directly to bone metastases.

Clinical trials found radium-223 improved survival by about 3 months compared to placebo. Since prostate cancer often spreads to bones, radium-223 can be an effective option when chemotherapy and anti-androgens no longer control cancer.

Immunotherapy

Immunotherapy drugs that harness the body's immune system to attack cancer have become standard treatments for many cancer types. While immunotherapies have not yet been shown to definitively prolong survival for prostate cancer, they can provide moderate benefit for some men.

The immunotherapy drugs Yervoy (ipilimumab) and Keytruda (pembrolizumab) are being studied in ongoing prostate cancer clinical trials, generally in combination with other medications.

Optimizing Quality of Life on Treatment

Living with advanced prostate cancer on long-term treatments like Erleada can impact quality of life. It is important for patients to build a robust support system and utilize every resource available to maintain comfort and enjoyment of life.

Manage Side Effects

Work closely with your medical team to minimize treatment side effects. Stay hydrated, exercise if possible, and eat a balanced, nutritious diet. Ask about medications to prevent nausea, fatigue and pain if needed.

Seek Emotional Support

Share feelings openly with loved ones and join a support group to gain perspective from others experiencing similar challenges. Anxiety and depression are common and treatable. Don't hesitate to ask your doctor for help.

Incorporate Rest and Relaxation

Make time every day for rest periods to restore energy levels. Gentle activities like walking, yoga, meditation, or just sitting outdoors can also boost mood and wellbeing during cancer treatment.

Maintain Relationships

Reaching out to family and friends for company and laughter can lift spirits. Allow loved ones to provide practical help with meals, errands, transportation and other daily needs.

Focus on Enjoyment

When possible, continue engaging in hobbies that bring purpose and pleasure, even if you need to adapt activities to accommodate limitations. Savoring small joys can make treatment more bearable.

Dealing with advanced prostate cancer takes tremendous courage and resilience. While the treatments can be grueling, the care from your medical team and support from loved ones will help guide you on the path forward as you fight your cancer.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.