Dr. Kohli on the Use of Enzalutamide and Apalutamide in mHSPC

Manish Kohli, MD, vice chair, Department of Genitourinary Oncology, Moffitt Cancer Center, discusses the use of enzalutamide (Xtandi) and apalutamide (Erleada) in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

In the phase 3 ENZAMET study, investigators evaluated the combination of enzalutamide with docetaxel in men with mHSPC. The seizure rates, in addition to the neuropathy and fatigue rates, were higher with the combination. As the data mature, it will be important to assess the risk-benefit ratio of adding another agent to the mix, says Kohli.

Apalutamide is another option based on the results from the phase 3 TITAN trial. The interim results from the trial are comparable with abiraterone acetate (Zytiga) and docetaxel, says Kohli. Though, there were some extra adverse effects (AEs), such as pruritus and rash, which were not seen with the other drugs. However, each agent has a different set of AEs. The decision of which agent to pursue largely depends on tolerability, concludes Kohli.