This leaflet provides information on a course of treatment called apalutamide. The leaflet will explain what this is, when and how it will be given. It will also tell you about common side effects that you may experience. Contact telephone numbers are given at the end of the leaflet.
Apalutamide is a hormonal treatment which is given as tablets. Testosterone can stimulate prostate cancer growth. Hormonal treatments for prostate cancer work by reducing testosterone levels.
Your doctor has prescribed this therapy because it has been found to be effective in some patients with prostate cancer.
Apalutamide works in a different way to other hormone treatments given for prostate cancer.
At first you will be reviewed monthly either in the outpatient clinic or by phone assessment,, then less regularly, about 3 monthly. At these appointments you will have blood tests and we will monitor your blood pressure. We will check how you are feeling and discuss any problems you may have. This is so we can check how treatment is affecting you.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
Apalutamide tablets should be taken once a day. Tablets can be taken anytime, but try and take them at approximately the same time every day. The tablets should be swallowed whole with a glass of water. They must not be chewed or crushed.
The amount you need to take will be clearly marked on the box.
Please contact Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet, please ask for the treatment line.
Your tablets should be stored in their original packaging in a safe place away from children. They should be kept in a cool dry place (below 25oC). Any unused tablets should be returned to the hospital pharmacy or your local chemist for safe disposal.
There are a number of possible side effects which can occur. The doctor, nurses and pharmacy team can give you advice or answer any questions you may have.
The treatment can make you feel more tired than usual. It is important to listen to your body and rest if you need to, but carry on normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
This treatment may cause a rise in blood pressure for some patients. We will check your blood pressure before you start treatment, and at each clinic visit. Please tell us if you are already receiving treatment for high blood pressure. If you have suffered from high blood pressure in the past but it is well controlled, you will still be able to receive this treatment.
Athralgia is joint and muscle aches and pains, this occurs in about 17% of patients and is usually mild, if this occurs you can take whatever painkiller you would usually take for a headache
This treatment may cause some heart problems. The risk of developing serious heart problems is low. Your doctor will discuss this with your and arrange for your heart function to be tested before treatment if needed.
If you have a heart condition or you take any heart medication, please tell your doctor before you start treatment.
You may experience a skin reaction with apalutamide. This is usually an itchy rash that causes mild discomfort. For a small number of people this reaction may be more severe. A severe rash would affect a large part of your body, may be painful and may become infected.
This skin reaction is temporary and should resolve completely after you have finished treatment. If you develop a severe skin reactions which is causing pain or stopping you carrying out your normal activities, please contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having any cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Hypothroidism – this is a rare side effect, a very small number of patients on apalutamide may experience low levels of the hormone thyroxine, if this occurs you may feel more tired than usual, feel sensitive to the cold, put on weight and have problems with constipation. This can be monitored through blood tests.
Hot flushes are experienced by about 23% of patients having apalutamide treatment. Please see Macmillan link below for more information on hot flushes
https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hot-flushes-and-sweating
If you have concerns about the symptoms below: please discuss them with your specialist nurse or with your oncology doctor.
Patients can develop bone thinning or osteoporosis over time. This may increase you risk of falls and fractures of your bones. Regular walking and exercises that offer resistance, such as lifting weights can help with this. A healthy diet can also help with this. Discuss this with your specialist nurse or oncology doctor.
A very small number of patients (less than 1%) can develop fits while taking apalutamide. It is important that you tell your doctor if you have ever had a fit, or are currently receiving treatment for fits. Also tell your doctor if you have had a brain injury within in the last 12 months, or if you have ever had a brain tumour or a stroke. If you do experience a fit you should stop taking your apalutamide and telephone Velindre Cancer Centre on the treatment helpline; the telephone number is at the end of the leaflet.
It is important that you do not father a child whilst having this treatment and for 3 months afterwards. This is because the apalutamide may damage the unborn baby. You will need to use a condom and a 2nd form of birth control if you are in a relationship with someone who is of childbearing age.
Is it alright to take other medicines?
If you are taking other medicines please inform your doctor, nurse or pharmacist so they know what medicines you are taking. This includes prescription and non-prescription medicines, vitamins or herbal supplements, as there are a small number of medicines that you may have to avoid.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre Cancer Centre if you are concerned about any side-effects.
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Macmillan freephone Helpline 0808 808 0000
Tenovus freephone 0808 808 1010
cancer helpline
This information is also available in Welsh
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years. Prepared April 2020