Dr. Morris on Safety Profiles of AR Inhibitors in Prostate Cancer

David Morris, MD, FACS, a urologist at Urology Associates, P.C., discusses the safety profiles and common adverse events (AEs) related to the androgen receptor inhibitors apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa) for prostate cancer.

The safety profiles between apalutamide, enzalutamide, and darolutamide are nuanced and do not indicate a clear winner when choosing one to give a patient, explains Morris. All the agents are associated with increased fatigue, though it is stronger with enzalutamide and apalutamide.

Patients with a history of seizures are excluded from receiving enzalutamide due to early trial experience. For apalutamide, a rash signal is forefront. For the most part, those AEs are manageable, low-grade, and may not be a strong enough reason to avoid any of the drugs or discontinue treatment says Morris, adding that they can often be managed with active drug therapy, according to Morris.

It is challenging to compare apalutamide, enzalutamide, and darolutamide through the trials, says Morris, because they are all measured differently. For example, there are different time intervals for measuring and capturing AEs during the trial, concludes Morris.