Oncologists are always a little anxious about the toxicities of the long-term use of medications for prostate cancer, Dr Markowski told Cancer Therapy Advisor.

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“We are not curing these men of prostate cancer, so the goal for treatment is to prolong their lives, while at the same time maintaining a good quality of life,” he said.

All drugs have toxicities, Dr Markowski acknowledged. But findings from SPARTAN that were previously published in the New England Journal of Medicine implied that there was potential reason for concern about patients’ quality of life during apalutamide therapy given its adverse event profile compared with placebo.

“This paper by Saad and colleagues answers that question,” he said. “These patients on apalutamide are not experiencing a worsening QoL. For the most part, they hold steady over the treatment course.”

In addition, findings from SPARTAN suggested that patients’ emotional well-being appeared to get better over time while they were receiving apalutamide, Dr Markowski said.

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“Even though there are toxicities, the patients themselves feel pretty good about how they are doing.” Dr Markowski said. “Their PSA [prostate-specific antigen] is going down, their cancer is in remission. The drug is efficacious and doesn’t impact patient quality of life.”

“This is a population we don’t see much, but it’s important to know if you do have a patient with nonmetastatic CRPC, apalutamide or enzalutamide are efficacious and have been shown not to impact quality of life,” Dr Markowski said.


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  2. Gourd E. Apalutamide shows efficacy in prostate cancer. Lancet Oncol. 2018;19(3):e149.
  3. Saad F, Cella D, Basch E, et al. Effect of apalutamide on health-related quality of life in patients with non-metastatic castration-resistant prostate cancer: an analysis of the SPARTAN randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2018;19(10):1404-1416.
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