Enzalutamide and sleep apnea: an emerging central nervous system side-effect?

Labrize, F.; Cany, Laurent; Massard, C.; Loriot, Y.; Sargos, P.; Gross‐Goupil, Marine; Roubaud, Guilhem

doi:10.1093/annonc/mdv481

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Because of their CYP inhibition capability, both agents have the potential for CYP-mediated drug interactions, mainly for those that are substrates to CYP3A4, CYP2C9, and CYP2C19 enzymes [80,81], with resulting altered activity of comedications such as anticoagulants, antihypertensives, opioid analgesics, and proton pump inhibitors [74,75,[80][81][82][83]. Apalutamide and enzalutamide are also able to penetrate the blood-brain barrier and thus achieve active central nervous system concentrations, where they inhibit gamma-aminobutyric acid receptors [84]. This may result in an increased risk of seizures [69,71,72].…”

Section: Pharmacological Interactions Of Androgen Receptor Inhibitorsmentioning

confidence: 99%

Nonmetastatic Castration-Resistant Prostate Cancer: Current Challenges and Trends

et al. 2022

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Prostate carcinoma is a highly prevalent biologically and clinically diverse disease, generally associated with a consistent elevation of prostate-specific antigen levels. Castration-resistant prostate cancer represents a heterogeneous clinical setting that ranges from patients with an asymptomatic prostate-specific antigen elevation after hormone blockade failure and good performance status to patients with significant debilitating symptoms and rapidly progressive disease, leading to death. Nonmetastatic castration-resistant prostate cancer is a transient disease stage defined over specific criteria established within a sensitive time period. The majority of the patients with nonmetastatic castration-resistant prostate cancer will eventually develop metastatic lesions, associated with prostate cancer-specific morbidity and mortality. However, progression to metastatic disease is a heterogeneous process still not fully understood, with studies suggesting that younger age, high Gleason score (> 7), high prostate-specific antigen levels, reduced prostate-specific antigen doubling time (< 6 months), and a rapid alkaline phosphatase rise as potentially associated factors. Although the nonmetastatic castration-resistant prostate cancer treatment landscape has substantially evolved in recent years, the disease heterogeneity makes treatment decisions for this population challenging in the effort to achieve a balance between the risk of disease progression and the toxicity of new treatments in patients who often have associated comorbidities, yet are generally asymptomatic. The present article addresses the current main challenges in nonmetastatic castration-resistant prostate cancer management, including in diagnosis, owing to the development of new imaging modalities with a direct impact in disease detection, prognostic classification, as a result of the traditionally oversimplified definition of disease aggressiveness (mainly based on prostate-specific antigen doubling time), and patient selection for the most adequate treatment.

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Section: Pharmacological Interactions Of Androgen Receptor Inhibitorsmentioning

confidence: 99%

Nonmetastatic Castration-Resistant Prostate Cancer: Current Challenges and Trends

et al. 2022

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“…The literature is scarce on the effects of novel hormonal agents on sleep quality, except only one letter to the editor that was not included in this systematic review. The authors reported the case of a 58-year-old man who developed sleep apnea 6 weeks after starting treatment with enzalutamide [ 73 ]. Enzalutamide is generally well tolerated, and studies reported a favorable toxicity profile.…”

Section: Resultsmentioning

confidence: 99%

Prostate Cancer and Sleep Disorders: A Systematic Review

Sparasci

Napoli

Rossi

et al. 2022

Cancers

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Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.

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“…The effect of these treatments on OSA has not been studied well, although there is a case report of enzalutamide, an antiandrogen medication, being associated with OSA. 23 The study of these patients may prove enlightening in understanding the effect of sex hormones on OSA.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series

Robertson

Lerner

Collen

et al. 2019

Journal of Clinical Sleep Medicine

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The effect of hormone therapy on sleep-disordered breathing in transgender patients has not been described. We present three cases of patients undergoing gender reassignment and treated with hormone replacement. The first case was a transgender woman (assigned male at birth) with a prolonged history of severe obstructive sleep apnea (OSA) that resolved following initiation of female sex hormones. The second and third cases both address transgender males (assigned female at birth) in whom OSA developed following initiation of male sex hormones (with pretreatment polysomnography documenting absence of OSA). The growing interest in transgender health warrants further evaluation of the effects of related therapies on sleep and sleep-disordered breathing.

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Enzalutamide and sleep apnea: an emerging central nervous system side-effect?

Cited by 5 publications

References 3 publications

Nonmetastatic Castration-Resistant Prostate Cancer: Current Challenges and Trends

Nonmetastatic Castration-Resistant Prostate Cancer: Current Challenges and Trends

Prostate Cancer and Sleep Disorders: A Systematic Review

The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series

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