Dr. Hurwitz Compares the Utility of Antiandrogens in Nonmetastatic CRPC

Michael E. Hurwitz, MD, PhD, associate professor of internal medicine, Yale Cancer Center, compares the utility of antiandrogens in nonmetastatic castration-resistant prostate cancer (CRPC).

In nonmetastatic CRPC, apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa) are FDA approved antiandrogen therapies. These agents have demonstrated similar clinical activity; however, they have not been compared in head-to-head trials. Notably, apalutamide and enzalutamide are almost structurally identical and share similar toxicity profiles, Hurwitz says.

Conversely, darolutamide is structurally different from apalutamide and enzalutamide and does not cross the blood-brain barrier as readily as the other agents. Patients also seem to experience fewer adverse effects (AEs), such as fatigue, falls, and fractures with darolutamide versus apalutamide and enzalutamide. As such, for patients who are worried about the risk of AEs, darolutamide could be the optimal antiandrogen, Hurwitz concludes.