Fred Saad, MD, FRCS, professor and chief of Urology, director of Genitourinary Oncology, Raymond Garneau Chair in Prostate Cancer, University of Montreal Hospital Center, and director, Prostate Cancer Research, Montreal Cancer Institute, discusses unique characteristics of apalutamide (Erleada) compared with other antiandrogen agents in nonmetastatic castration-resistant prostate cancer (M0CRPC).

Apalutamide, enzalutamide (Xtandi), and darolutamide (Nubeqa) have shown similar efficacy and quality of life (QoL) data in patients with M0CRPC, says Saad.

In a QoL analysis of apalutamide, asymptomatic patients were given antiandrogen therapy that had the potential to cause adverse events, explains Saad. However, patients’ QoL remained stable with no signs of deterioration compared with placebo.

Apalutamide, an androgen receptor-targeted agent, differs from androgen synthesis inhibitors such as abiraterone acetate (Zytiga) in that it has a different mechanism of action, says Saad. Additionally, rates of fatigue appear to be lower with apalutamide compared with historical rates in this setting.