Apalutamide

Apalutamide is also known as Erleada. You pronounce apalutamide as a-pa-loo-ta-mide. It is a type of hormone therapy known as an anti androgen .

Doctors use it to treat men with prostate cancer:

• that has spread to another part of the body and who can have hormone treatment for their cancer (hormone sensitive prostate cancer)
• that is growing despite having treatment to lower the level of testosterone (castration resistant prostate cancer) and are at a high risk of their cancer spreading to another part of the body

How does apalutamide work?

Apalutamide works by preventing the hormone testosterone from stimulating the cancer cells to grow. It also increases the rate of death of cancer cells (apoptosis ).

How do you take apalutamide?

Apalutamide is a tablet. The usual dose is 4 tablets every day.

You take apalutamide with another type of hormone treatment.

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

How often do you take apalutamide?

You take apalutamide once a day. You swallow them whole with a glass of water. You can take them either with food or between meals.

You continue to take them as long as they are helping and the side effects aren’t too bad.

Tests

You might have blood tests before starting treatment and during your treatment. They check your general health and might check your levels of blood cells and other substances in the blood.

What are the side effects of apalutamide?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 out of 100 people (more than 10%). You might have one or more of them. They include:

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Joint pain

Tell your healthcare team if you have joint pain. They might suggest taking painkillers that could help.

Skin rash

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. Your nurse checks your blood pressure regularly. 

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Falls and broken bones

You might have an increased risk of falls and breaking your bones.

Hot flushes

We have some tips for coping with hot flushes in men. This information also includes some of the possible treatments. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• muscle spasms
• hair loss
• change to taste
• a high level of fats such as cholesterol and triglycerides in the blood – you have blood tests to check this
• an increased risk of heart disease such as chest pain and heart attack
• low blood flow to part of the brain causing a stroke or a mini stroke – symptoms include drooping face, numbness or weakness on one side of the body, feeling confused and difficulty speaking
• too little thyroid hormone (hypothyroidism) causing tiredness and having difficulty to get going in the morning

Rare side effect

You might have seizures (fits). This side effect happens in fewer than 1 in 100 people (fewer than 1%). 

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• changes to the heart beat shown on a heart trace (ECG)
• a widespread rash, high temperature and enlarged lymph nodes
• a severe skin reaction that may start as tender red patches leading to peeling or blistering of the skin. You might feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening. Contact your healthcare team.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you want to have a baby in the future. You may be able to store sperm before starting treatment.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to get someone pregnant while you are having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if your partner becomes pregnant while you're having treatment.

You should use contraception during treatment and for 3 months after treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.