What would Iwona Skoneczna do?
We have 3 live-prolonging options for Adam, who experienced M0 CRPC with a short PSADT: apalutamide, darolutamide and enzalutamide [1-3]. As most men at this stage, he is asymptomatic and willing to control the relapsing cancer, while minimizing treatment-related adverse events. With darolutamide having negligible blood-brain barrier penetration, he may have the lowest potential for central nervous system-related side effects, a low chance of significant fatigue (<0.5%), only 5% risk of falls, less cognitive changes (memory impairment and disturbances in attention) and no risk of seizures, so he may continue his occupational activity in the high mountains. Importantly, darolutamide inhibits both wild-type and mutant AR and retains its activity against AR mutations currently known to cause resistance to enzalutamide and apalutamide, which may be of additional value [4].
References:
- Small EJ, et al. Final survival results from SPARTAN, a phase III study of apalutamide versus placebo in patients with non-metastatic castration-resistant prostate cancer. J Clin Oncol 2020;38(Suppl 15):abs.5516
- Fizazi K, et al. Overall survival results of phase III ARAMIS study of darolutamide added to androgen deprivation therapy for non-metastatic castration-resistant prostate cancer. J Clin Oncol 2020;38(Suppl 15):abs.5514
- Sternberg CN, et al. Final overall survival from PROSPER: a phase III, randomised, double-blind, placebo-controlled study of enzalutamide in men with non-metastatic castration-resistant prostate cancer. J Clin Oncol 2020;38(Suppl 15):abs.5515
- Fizazi K, et al. Clinical development of darolutamide: a novel androgen receptor antagonist for the treatment of prostate cancer. Clin Genitourin Cancer 2018;16(5):332-40