Dr. Choudhury on the Safety Profiles of Antiandrogens in Nonmetastatic CRPC

Atish D. Choudhury, MD, PhD, co-director of the Prostate Cancer Center, senior physician, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, compares the safety profiles of antiandrogen agents in nonmetastatic castration-resistant prostate cancer (CRPC).

Darolutamide (Nubeqa), enzalutamide (Xtandi), and apalutamide (Erleada) have demonstrated similar overall survival benefits for men with nonmetastatic CRPC who are receiving androgen deprivation therapy. However, differences regarding safety should be considered when selecting between the 3 agents, explains Choudhury.

Enzalutamide is associated with increased risk of fatigue, fractures, and falls compared with darolutamide and apalutamide, says Choudhury. Apalutamide, unlike the other 2 agents, has a risk of rash.

Apalutamide is also associated with hypothyroidism, Choudhury says. Although patients who develop hypothyroidism generally remain asymptomatic, it is an adverse effect to be aware of.

Darolutamide appears to be better tolerated versus apalutamide and enzalutamide, though it can cause fatigue, Choudhury adds.

Overall, darolutamide, apalutamide, and enzalutamide offer 3 reasonable options to treat patients with nonmetastatic CRPC, and treatment selection will likely come down to cost and insurance coverage, concludes Choudhury.