Dr. Heath on the Toxicity Profiles of Oral Antiandrogens in Nonmetastatic CRPC

Elisabeth I. Heath, MD, FACP, associate center director of Translational Sciences, lead of the Genitourinary Oncology Multidisciplinary Team, medical director of the Infusion Center, and director of Prostate Cancer Research at Barbara Ann Karmanos Cancer Institute, and professor of oncology at Wayne State University School of Medicine, discusses the safety profiles of apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa) in nonmetastatic castration-resistant prostate cancer.

Patients with nonmetastatic disease who receive antiandrogens can experience fatigue, which is consistent with their use in the metastatic castration-resistant setting, says Heath. Regarding the risk of falls and fractures, patients aged 75 or older have a slightly higher incidence of these events; however, it remains unknown if that is due to a balance issue, or the neurologic toxicity of the antiandrogen, says Heath.

Darolutamide shows a lower incidence of neurologic toxicity, which may be a result of its mechanism of action or lower blood—brain barrier penetration, adds Heath.

Lastly, in the phase III PROSPER trial, more cardiovascular deaths were observed in the enzalutamide arm. Therefore, patients who are already experiencing cardiovascular issues may not be optimal candidates for enzalutamide, concludes Heath.