Considerations for Apalutamide Versus Enzalutamide in Prostate Cancer Treatment

At the 2019 Hematology/Oncology Pharmacy Association Annual Conference Lisa Holle, PharmD, BCOP, FHOPA, associate clinical professor at the University of Connecticut, explained which patient populations would best benefit from either apalutamide or enzalutamide in the treatment of non-metastatic prostate cancer.

Transcript

In the apalutamide trial, they did include patients who had, they had non-metastatic disease, but if they had 1 lymph node that was 2 centimeters or less and it was below the iliac bifurcation, those patients could receive apalutamide and therefore could have a benefit of receiving this drug. In the enzalutamide trial, they did include patients who had a baseline PSA of 2, and so that might be an important factor to consider for patients who might fit into that category. In terms of side effects, apalutamide was associated with more hypothyroidism, rash, falls, and fractures. And so patients who might already have hypothyroidism or a thyroid disorder may not be the best candidate for that drug or have a history of osteopenia or osteoporosis, there may be a higher risk then for falls or fractures. So that again would be a population I probably wouldn’t consider apalutamide in, enzalutamide might be better. In terms of enzalutamide side effects, there is a higher chance of hypertension when you look at the actual numbers compared to apalutamide so that might be another consideration.