Nurses Are Significant to Practice Implications for Enzalutamide Treatment in nmCRPC

Data from the phase 3 PROSPER trial (NCT02003924) of enzalutamide (Xtandi) revealed significant implications for the role nurses play in the treatment of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC), according to a poster presentation of the data at the Oncology Nursing Society’s 46th Annual Congress.

“As treatment options expand, nurses will play an increasingly important role in the clinical management of patients with nmCRPC, including patients treated with enzalutamide,” wrote the investigators.

Monique Williams, lead author and study presenter from Leidos Biomedical Research Inc., explained that nurses are in a unique position to provide adequate care and education to patients with nmCRPC.

Among other things, Williams mentions patient education, multidisciplinary team management, the monitoring of adverse events and comorbidities, drug interaction management, and overall holistic care as integral implications in this practice setting for nurses.

To maintain routine healthcare and mitigate potential comorbidities during treatment such as hypertension, cardiovascular disease, diabetes, and psychiatric illness, nurses should engage other specialists or primary physicians.

More, as far as the safety profile of patients, the early identification of adverse events is key, as it improves medication adherence. Telehealth visits are also beneficial to allow convenience to patients and promote compliance.

Nurses need to ask patients about all their prescription and over-the-counter medications to avoid possible interactions with treatment. These include any herbal supplements a patient might be taking.

Overall, nurses should emphasize a holistic care plan for patients, taking into account the patient’s biological, social, psychosocial, and spiritual well-being. These steps should emphasize and provide referrals, encourage exercise, promote a healthy diet, suggest nonpharmaceutical resources to reduce pain and stress, and advise on sleep hygiene.

“In recent years, the development of novel hormone therapies (NHTs), such as enzalutamide, has changed the treatment landscape for men with nmCRPC and nurses will play a critical role in their management,” wrote the investigators in their poster of the data.

The trial randomly assigned 1401 patients to receive either enzalutamide 140 mg/day plus androgen-deprivation therapy (ADT; n = 933) or placebo plus ADT (n = 468).

Overall, the median treatment duration for the cohort was 33.9 months for patients in the enzalutamide group compared with 14.2 months for patients in the placebo group. More, median metastatic-free survival, which serves as a surrogate for overall survival in patients with nmCRPC, was recorded at 36.6 months for the enzalutamide group versus 14.7 months for the placebo group.

When compared with the placebo treatment, enzalutamide treatment was associated with a 27% lower risk of death, representing a significant improvement in treatment outcomes. Median overall survival with enzalutamide compared with placebo was 67.0 months versus 56.3 months, respectively.

Further, the time to PSA progression was recorded as longer in patients treated with enzalutamide when compared with patients treated with placebo. Also, these PSA responses were significantly associated with metastatic-free survival.

The safety profile was similar to that of the existing profiles for enzalutamide treatment. Common adverse events in the enzalutamide group included cardiovascular events, falls, fatigue, and fractures.

“As oncology nurses, we are on the front lines of patient care. We are likely the most accessible healthcare professionals,” explained Williams in her presentation of the data. “We will be assessing patients with nmCRPC, providing education, and coordinating the care for enzalutamide-treated patients. It is key that nurses properly educate on the once daily administration of enzalutamide.”

Reference:

Williams M, Hussain M, Sternberg CN, et al. Treatment with Enzalutamide in Men with Non-metastatic Prostate Cancer from the PROSPER Trial. Presented at: Oncology Nursing Society 46th Annual Congress. April 20, 22, 27 & 29, 2021. Virtual.