© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
TABLE 3.
Medications for prevention of skeletal related events secondary to advanced or castrate resistant
prostate cancer (CRPC) and newer agents for treatment of CRPC
Name
Dose
Mechanism
Side effects/Notes
(
Brand name)
Prevention of skeletal related events in patients with bone metastases
Zoledronic acid
4
mg IV infusion over
Bisphosphonate Reduce dose in patients with renal
(
Zometa)
15
min every 3-4 weeks
insufficiency; rare reports of
osteonecrosis of the jaw; given with
Vitamin D and calcium
supplementation (indicated for
treatment of bone metastases only in
Canada)
Denosumab
120
mg every 4 weeks SC
Monoclonal
Severe hypocalcemia can be seen; reports
(
Xgeva)
antibody
of osteonecrosis of the jaw; given with
targeting
Vitamin D and calcium
RANKL
supplementation (Note there is
different formulation/ dosing than
denosumab [Prolia] used in female
osteoporosis)
Treatment of CRPC
Docetaxel
75
mg/m
2
IV infusion
Suppresses
Should not be given in patients with
(
Taxotere)
over 1 hour every 3 weeks
microtubule
elevated LFTs or who are
Given in combination with
assembly
neutropenic; severe fluid retention
5
mg prednisone po
dynamics
can also result
twice daily
Cabazitaxel
25
mg/m
2
IV infusion
Same as for
Contraindicated in neutropenic
(
Jevtana)
over 1 hour every 3 weeks
docetaxel
patients or those with previous
Given in combination with
hypersensitivity; renal and GI
10
mg prednisone po
toxicity reported
once daily
Sipuleucel-T
Leukapheresis process
Utilizes patients Fevers; chills; fatigue; weakness;
(
US only)
2-3
days prior to each dose
own immune
respiratory issues; dizziness; headache;
to collect patient’s own
cells to target
GI upset all reported
immune cells; IV infusion in
cancer cells
3
doses given 2 weeks apart
Abiraterone
1
g (4 x 250 mg tabs) po once
Androgen
Myopathy, joint pain, hot flushes,
(
Zytiga)
daily, taken on an empty
biosynthesis
diarrhea, urinary tract infection, cough.
stomach. Given in combination inhibitor
Increases mineralocorticoid production
with low dose prednisone
by adrenals and may cause hypertension,
(10
mg po daily)
hypokalemia, fluid retention. Use with
caution in patients with CV disease
Enzalutamide
160
mg (4 x 40 mg caps) po
Androgen
Weakness, fatigue, back pain, diarrhea,
(
Xtandi,
once daily, taken during or
receptor
musculoskeletal and joint pain,
[
US only])
before meals. Given with or
inhibitor
hot flushes, headache, respiratory
without prednisone
infections, dizziness, anxiety,
hypertension. 1% of patients in
clinical trial experienced seizure
RehsiaAND Shayegan
34
