TL;DR
- Caverta is a targeted oral therapy for advanced prostate cancer, acting as an androgen‑receptor inhibitor.
- Standard dose is 160mg once daily on an empty stomach; dose adjustments may be needed for liver issues.
- Typical side effects include fatigue, hot‑flashes, and mild hypertension; serious risks involve seizures and liver toxicity.
- When compared with Xtandi (enzalutamide) and Erleada (apalutamide), Caverta offers fewer drug‑drug interactions but a higher seizure warning.
- Always discuss with your oncologist before starting, especially if you have a history of seizures or liver disease.
What Is Caverta and How It Works
Caverta (generic name: enzalutamide) is part of a class called androgen‑receptor inhibitors. Prostate cancer cells rely heavily on testosterone to grow. By binding to the androgen receptor, Caverta blocks testosterone from attaching, effectively starving the cancer cells of the signal they need to multiply.
The drug was approved in Australia in 2022 for non‑metastatic castration‑resistant prostate cancer (nmCRPC) and later expanded to metastatic settings. Clinical trials (e.g., the PROSPER study) showed a 31% reduction in risk of radiographic progression compared with placebo, making it a go‑to option when hormone therapy alone no longer suffices.
Because it works systemically, Caverta is taken orally as a tablet, allowing patients to stay at home rather than receiving intravenous infusions. The convenience, however, comes with a need for strict adherence-missing doses can let the cancer regain momentum.
Dosage Guidelines and How to Take It Safely
The approved regimen for most patients is a single 160mg tablet taken once daily, preferably at the same time each day. Here’s a quick checklist to keep you on track:
- Empty Stomach: Swallow the tablet with a glass of water at least 30 minutes before eating or 2hours after a meal. Food can reduce absorption by up to 20%.
- Set a daily alarm on your phone to reduce missed doses.
- If you vomit within two hours of taking Caverta, retake the full dose-do not halve it.
- Store the tablets at room temperature, away from moisture and direct sunlight.
- Inform your pharmacist of any over‑the‑counter meds, especially supplements containing St. John’s wort, which can lower Caverta levels.
Dose adjustments are recommended for patients with moderate to severe hepatic impairment (Child‑Pugh B or C). In such cases, the dose is reduced to 80mg daily, and liver function tests are monitored every 2-4 weeks during the first three months.
Kidney function does not significantly affect Caverta clearance, so no routine dose reduction is needed for renal impairment, but regular blood work is still advised.
Common Side Effects and When to Seek Help
Understanding what to expect can prevent panic and ensure early intervention when necessary. The most frequently reported adverse events (taken from the PROSPER and AFFIRM trials) include:
- Fatigue (≈30% of patients)
- Hot‑flashes and night sweats (≈25%)
- Hypertension (≈15%)
- Back pain or musculoskeletal discomfort (≈12%)
- Diarrhoea (≈10%)
Serious, though less common, issues to watch for are:
- Seizures - estimated incidence 0.6%; risk rises with prior seizure history or brain metastases.
- Elevated liver enzymes - a rise >3× ULN warrants dose interruption.
- Cardiac arrhythmias - monitor ECG if you have known QT prolongation.
If you experience any of the following, contact your oncologist promptly:
- New or worsening seizures, even if you’ve never had one before.
- Persistent vomiting, jaundice, or dark urine (signs of liver trouble).
- Sudden, severe headaches or visual changes.
- Chest pain or palpitations suggestive of heart rhythm problems.
Minor side effects like mild fatigue can often be managed with lifestyle tweaks: regular light exercise, a balanced diet, and short daytime naps. Hydration helps with hot‑flashes, and over‑the‑counter acetaminophen can ease occasional aches-but always double‑check with your health team.
Comparing Caverta with Other Prostate Cancer Drugs
Choosing the right therapy isn’t just about efficacy; it’s also about how the drug fits your life, existing health conditions, and other medications. Below is a snapshot comparison of Caverta, Xtandi (enzalutamide), and Erleada (apalutamide), the three leading androgen‑receptor inhibitors in Australia.
| Feature | Caverta (enzalutamide) | Xtandi (enzalutamide) | Erleada (apalutamide) |
|---|---|---|---|
| Approved Indications | nmCRPC, mCSPC, mCRPC | Same as Caverta (brand‑name version) | nmCRPC, mCSPC |
| Typical Dose | 160mg once daily | 160mg once daily | 240mg once daily |
| Seizure Risk | 0.6% (higher warning) | 0.6% (same molecule) | 0.2% |
| Drug‑Drug Interactions | Moderate - CYP2C8 & CYP3A4 substrate | Same as Caverta | Lower - fewer CYP pathways |
| Common Side‑Effects | Fatigue, hot‑flashes, hypertension | Similar profile | Rash, hypothyroidism, falls |
| Cost (2025, AU$ per month) | $2,400 | $2,450 (brand premium) | $2,300 |
Key take‑aways:
- If you’re already on medications that strongly induce CYP3A4 (like certain anticonvulsants), Erleada may be easier to manage.
- Patients with a history of seizures generally prefer Erleada because of its lower seizure incidence.
- When cost is the primary concern, the generic Caverta often beats the brand‑name Xtandi.
Ultimately, the decision should involve a frank discussion with your oncologist about your medical history, lifestyle, and personal priorities.
Mini‑FAQ: Your Most Pressing Follow‑Ups
Can I take Caverta with testosterone replacement therapy?
Usually not recommended. The drug’s purpose is to block testosterone’s effect; adding external testosterone defeats the therapy.
How long do I stay on Caverta?
Most clinicians continue until disease progression, unacceptable toxicity, or patient choice. Some stay for years; regular scans guide the timeline.
Is Caverta safe after prostate surgery?
Yes, if you still have residual disease or rising PSA, Caverta can be used as adjuvant therapy. Discuss timing with your surgeon.
Do I need to stop the drug before surgery?
A 2‑week washout is typical before major surgery to reduce bleeding risk and allow blood pressure to stabilise.
Can women be prescribed Caverta?
Currently, Caverta is only approved for men with prostate cancer. Off‑label use in women is not supported by data.
Next Steps & Troubleshooting
If you’re starting Caverta, follow these actions:
- Baseline labs: Liver panel, PSA, CBC, and blood pressure.
- Medication review: Bring a list of every drug and supplement to your oncology appointment.
- Set reminders: Use a phone app or pillbox that alerts you at the same time daily.
- Track side effects: Keep a simple notebook noting any new symptoms; share it at each visit.
- Plan follow‑up: Schedule PSA testing every 3 months and imaging as advised.
If you miss a dose, take it as soon as you remember-unless it’s within 12hours of the next scheduled dose, in which case skip the missed one and resume regular timing. Never double‑dose.
Should severe side effects emerge, your doctor may pause therapy, lower the dose, or switch to an alternative like Erleada. Early communication is the best way to keep treatment effective and safe.
Remember, Caverta is a powerful tool in the fight against prostate cancer, but it works best when paired with vigilant monitoring and open dialogue with your healthcare team.
