A practical guide for the use of apalutamide for non-metastatic castration-resistant prostate cancer in Australia.

Studies of patients with castrate-resistant prostate cancer at high risk of developing overt metastases but with no current evidence of evaluable disease on computed tomography or bone scan non-metastatic castrate-resistant prostrate cancer have demonstrated increased metastasis-free survival and overall survival following treatment with the next-generation oral anti-androgen apalutamide (in addition to therapies that aim to lower testosterone to castrate levels) or luteinizing hormone-releasing hormone antagonist or surgical castration. Patients receiving apalutamide can be managed by medical oncologists, radiation oncologists, or urologists, preferably as part of a multidisciplinary team. However, the importance of additional safety monitoring for significant adverse effects and drug interactions should not be underestimated. The toxicities of apalutamide are manageable with experience and should be managed proactively to minimize their impact on patients. Monitoring of patients for apalutamide-specific toxicities, including skin rash, hypothyroidism, and QT prolongation should be carried out regularly, particularly in the first few months following initiation. Monitoring should continue alongside monitoring for toxicities of androgen deprivation, including cardiovascular risk, hot flashes, weight gain, bone health, muscle wasting, and diabetic risk. This review is a practical guide to the use of apalutamide describing the management of patients including dosing and administration, toxicities, potential drug interactions, and safety monitoring requirements.

Asia-Pacific journal of clinical oncology. 2024 Apr 19 [Epub ahead of print]

Gavin Marx, Simon Chowdhury, Laurence Krieger, Elizabeth Hovey, Jeremy Shapiro, Ben Tran, Thean Hsiang Tan, Siobhan Ng, Henry H Woo

San Clinical Trial Unit, Sydney Adventist Hospital, Integrated Cancer Centre, Wahroonga, Australia., Guy's and St Thomas' Hospitals, London, UK., Genesis Care, St Leonards, Sydney, Australia., Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia., Department of Medical Oncology, Cabrini Haematology and Oncology Centre, Malvern, Australia., Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia., Department of Medical Oncology, Royal Adelaide Hospital, Adelaide and Icon Cancer Centre, Adelaide, Australia., Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia., San Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, Australia.