Overview of the role of apalutamide in the management of advanced prostate cancer
Prostate cancer disease burden
Current treatment approaches and unmet needs for patients with advanced prostate cancer
Metastatic hormone-sensitive prostate cancer
Indication | Recommendation | Trial |
---|---|---|
nmCRPC | ADT + apalutamide ADT + enzalutamide ADT + darolutamide | SPARTAN [21] PROSPER [23] ARAMIS [25] |
mHSPC | ADT + apalutamide ADT + docetaxel | TITAN [15] STAMPEDE [9] CHAARTED [5] |
ADT + abiraterone acetate + prednisone | LATITUDE [7] STAMPEDE [10] | |
ADT + enzalutamide ± docetaxel | ENZAMET [13] | |
ADT + enzalutamide | ARCHES [12] |
Non-metastatic castration-resistant prostate cancer
Apalutamide key clinical data
High-risk nmCRPC
mHSPC
Expert opinion: role of apalutamide in clinical practice
Which patients are suitable for treatment with apalutamide?
What other considerations are important when prescribing apalutamide for a patient?
The role of imaging in treatment decisions
Real-world clinical experience with apalutamide
Clinical assessment/tests | Notes | |
---|---|---|
Before initiating treatment | Clinical history—review for cardiovascular events and concomitant medications Assessment of comorbidities/patient frailty Assess fracture/fall risk Consider baseline thyroid function test | If patient has a history of cardiovascular disease or cardiovascular events in past 6 months, refer to cardiologist before starting treatment Patients with a history of osteopenia/previous fractures/frailty need careful management (physiotherapy, vitamin D and/or calcium/antiresorptive agents) due to potential impact of apalutamide plus ADT on BMD |
Each clinic visit (monthly initially, then every 3 months) | Check PSA level Assessment of liver, kidney, and thyroid function Review of any patient-reported side effects (fatigue, skin rash) | |
Every 6 months | CT imaging and bone scan OR PSMA-PET |