Prostate cancer patients on enzalutamide may be at risk of fall, fracture

A recent study has found a higher prevalence of falls and fractures in prostate cancer patients receiving enzalutamide relative to those reported in previous clinical trials and postmarketing research.

“This could be due to the small patient population or the patient's comorbidities such as osteoporosis, bone metastases, or neuropathy,” the researchers said.

Twenty-six men with prostate cancer and treated with enzalutamide were included in the analysis. Of these, 96.1 percent had bone metastases, 15.4 percent had osteoporosis, 15.4 percent had osteopenia, and 34.6 percent had neuropathy at baseline.

The incidence of falls and fractures was 19.2 percent and 26.9 percent, respectively. The mean length of therapy was 19.44 months at time of a fall and 19 months at time of a fracture.

Among men who had a fall, 100 percent had arthralgia, 60 percent had neuropathy, 40 percent had a gait problem, 40 percent had hypertension, and 80 percent were at risk of fall. Among those with a fracture, 28.6 percent had osteoporosis, 42.9 percent had osteopenia, 100 percent had bone metastases, and 57.1 percent were on denosumab at time of fracture.

“Fall/fracture risk with enzalutamide and other risk factors for fall and fracture should be considered when discussing treatment and developing a monitoring plan,” the researchers said.

This retrospective chart review involved patients with prostate cancer treated with darolutamide, enzalutamide, or apalutamide from 1 March  2022 to 31 March 2023 at UConn Health Carole & Ray Neag Comprehensive Cancer Center, Farmington, Connecticut, US. 

The research team recorded data on basic demographics, history of fall or fracture, presence of metastases, fall risk, history of osteoporosis, prescribed second-generation androgen receptor antagonist, and other comorbidities. They assessed these data using descriptive statistics.