Apalutamide, also known as JNJ-56021927 or ARN-509, is a medication used to treat metastatic castration-resistant prostate cancer (mCRPC). It belongs to the class of drugs called androgen receptor inhibitors (ARIs), which work by blocking the activity of androgens like testosterone that fuel prostate cancer growth. Apalutamide was developed by Aragon Pharmaceuticals and acquired by Johnson & Johnson in 2013. It was approved by the US Food and Drug Administration (FDA) in February 2018 under the brand name Erleada.
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Health Benefits of Apalutamide:
Apalutamide has been shown to significantly improve progression-free survival (PFS) in patients with mCRPC who have not yet received chemotherapy. In a phase III clinical trial, apalutamide plus standard androgen deprivation therapy (ADT) reduced the risk of disease progression or death by 72% compared to placebo plus ADT. Apalutamide also delayed the time to initiation of chemotherapy and improved overall survival (OS) rates in this patient population.
Aside from its anti-cancer effects, apalutamide may also have beneficial effects on bone health, as prostate cancer often metastasizes to the bones and can cause bone loss and fractures. In preclinical studies, apalutamide was found to increase bone mineral density and prevent bone resorption. Additionally, apalutamide may have potential uses in other androgen-dependent diseases such as hirsutism and acne.
Apalutamide works by binding to the androgen receptor and preventing androgens like testosterone from activating it. This blocks the downstream signaling pathways that promote prostate cancer cell growth and survival. Unlike older ARIs such as bicalutamide and enzalutamide, apalutamide is able to bind to the receptor more tightly and selectively, with fewer off-target effects.
Overall, apalutamide has a favorable safety profile. The most common adverse events observed in clinical trials were fatigue, hypertension, rash, diarrhea, and nausea. However, these were generally mild to moderate in severity and manageable with supportive care or dose reductions. More serious side effects such as seizures, falls, and blood clots were rare.
The recommended dose of apalutamide is 240 mg (four 60 mg tablets) taken orally once daily with or without food. The tablets should be swallowed whole and not crushed or chewed. Apalutamide should be used in combination with ADT and continued until disease progression or unacceptable toxicity occurs.
In conclusion, apalutamide is a promising new treatment option for patients with mCRPC who have not yet received chemotherapy. Its ability to prolong PFS and delay the need for chemotherapy has significant clinical implications and may improve quality of life for these patients. Furthermore, apalutamide's favorable safety profile and potential benefits on bone health make it an attractive option for long-term use. Ongoing studies are exploring its use in combination with other treatments and in earlier stages of prostate cancer, which could expand its utility even further