Page 7 - Flipbook

Additional Monitoring for Patients Receiving Oral Cancer Agents
Recommended Monitoring Patients Receiving Apalutamide, Patients Receiving
Regardless of Treatment Strategy Darolutamide, Enzalutamide Abiraterone + Prednisone Patients Receiving Olaparib

Physical Exam • Per routine • Blood pressure at baseline and • Blood pressure q1mo • Investigate new or worsening
• Assess pain/pain management periodically • Fluid retention q1mo respiratory symptoms
• Assess fatigue and potential Apalutamide (pneumonitis, rare)
contributing factors • Assess for rash at each visit

Laboratory • PSA Apalutamide • Liver function (AST, ALT, and • CBC at baseline and q1mo x 12
• Testosterone • Assess TSH during treatment bilirubin) at baseline, q2w x 3 mo, mo, then periodically (cytopenia)
• Complete blood count (hypothyroidism) then q1mo
• Electrolytes (sodium, potassium, • Blood glucose levels in patients
calcium, magnesium, phosphorus) with pre-existing diabetes
• Fasting blood glucose (q3mo or more
frequently if needed) • Serum potassium q1mo
• Lipid profile (annually)
• Creatinine and CrCl
• Liver function (AST, ALT, and bilirubin)
• Albumin
• Alkaline phosphatase
• Lactate dehydrogenase

Imaging/ Imaging to detect disease progression/metastasis: • ECG at baseline and during
Radiology • Nuclear bone scan treatment (QTc prolongation)
• CT scan – abdomen/pelvis
• X-ray – chest
Other imaging:
• BMD with DXA – prior to initiating ADT, after
initiating ADT, then frequency depending on
bone loss observed with initial scans
Role of PET (eg, PSMA-PET) is still unclear and
benefits unknown.

Other • Assess for drug interactions prior to • If prednisone withdrawal
initiating a new therapy and with changes required, monitor for
to cancer and non-cancer medications adrenocortical insufficiency
• Dental evaluation prior to starting
bone-targeted therapy

References ERLEADA Product Monograph. Jul. 6, 2021. ZYTIGA Product Monograph. Jan. 4, 2021. LYNPARZA Product Monograph. May 31, 2021.
NUBEQA Product Monograph. Feb. 19, 2020.
XTANDI Product Monograph. Jun. 1, 2020.
Acronyms and abbreviations: ADT = androgen deprivation therapy; AR = androgen receptor; ARAT = androgen receptor-axis-targeted therapy; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMD = bone mineral density;
BS = bone scan; CBC = complete blood count; CrCl = creatinine clearance; CRPC = castration-resistant prostate cancer; CT = computed tomography; DXA = dual-energy x-ray absorptiometry; EBRT = external beam radiation therapy;
ECG = electrocardiogram; GU = genitourinary; HRR = homologous recombination repair; HRRm = HRR mutation; mCSPC = metastatic castration-sensitive prostate cancer; MRI = magnetic resonance imaging; nmCRPC = non-metastatic castration-
resistant prostate cancer; OS = overall survival; PET = positron emission tomography; PFS = progression-free survival; PSA = prostate-specific antigen; PSADT = PSA doubling time; PSMA = prostate-specific membrane antigen; qd = daily,
q1w = weekly; q6mo = every 6 months; q1yr = once yearly; rPFS = radiological progression-free survival.
Level of evidence/strength of recommendation: [L1sr] = level 1, strong recommendation; [L3sr] = level 3, strong recommendation; [L3wr] = level 3, weak recommendation; [EO] = expert opinion.

This tool card has been made possible through funding from Astellas Pharma Canada, Inc. in the form of an educational grant. ONC_2021_0003_CA