618P Apalutamide (APA) for advanced prostate cancer in older patients (pts): Combined analysis of TITAN & SPARTAN

Abstract

Background: Circulating tumor DNA (ctDNA) is an emerging resource for the diagnosis and prognosis of various types of cancer. However, characteristics and clinical utility of ctDNA is still largely unknown, especially in patients with genitourinary (GU) cancers.

Androgen receptor pathway inhibitors, prostate cancer, and older adults: a global Young International Society of Geriatric Oncology drug review

“…Furthermore, an examination of exposure-adjusted rates of AEs leading to treatment discontinuation falls, and ischemic heart disease from both trial cohorts revealed increased incidence with age regardless of treatment group, associated with an immediate 50% reduction in median treatment duration in those over 80. 18 Skin rash seen with apalutamide was also more common with age in the apalutamide groups. 18 ARAMIS was the first trial to demonstrate darolutamide safety and efficacy in nmCRPC.…”

“…18 Skin rash seen with apalutamide was also more common with age in the apalutamide groups. 18 ARAMIS was the first trial to demonstrate darolutamide safety and efficacy in nmCRPC. 11 The trial randomized 1509 nmCRPC patients receiving ADT to either darolutamide or placebo.…”

“…17 After its success in the mCSPC 19 and nmCRPC 10 settings, apalutamide has had one combined posthoc age-stratified analysis of its efficacy and safety of TITAN and SPARTAN cohorts. 18 By dividing patients into <65 and 65-79 and ⩾80 age groups, Shen et al found that while older adults received acceptable PSA response, quality of life (QoL), and PFS benefit, those over 80 did not receive a net survival benefit. Furthermore, an examination of exposure-adjusted rates of AEs leading to treatment discontinuation falls, and ischemic heart disease from both trial cohorts revealed increased incidence with age regardless of treatment group, associated with an immediate 50% reduction in median treatment duration in those over 80.…”

Role of apalutamide in the treatment landscape for patients with advanced prostate cancer: an expert opinion statement of European clinical practice

“…Apalutamide is effective in older as well as younger patients with high-risk nmCRPC and mHSPC. Post hoc analyses of data from SPARTAN and TITAN trials have shown that apalutamide improves radiographic PFS (rPFS) and OS in patients ≥ 65 and 65–79 years of age [ 32 ]. Although rates of AEs, particularly rash, were increased in older patients, HRQoL was maintained in the population of older patients, and they did not report increased bother from treatment side effects [ 32 ].…”

Apalutamide, Darolutamide and Enzalutamide for Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC): A Critical Review

“…However, apalutamide maintained favorable QoL, did not worse fatigue and the majority of patients reported being “not at all bothered” by side effects [ 44 ]. A sub-analysis also showed a good QoL profile in the older population [ 45 ]. In the PROSPER trial, more rates of fatigue, hot flushes, hypertension, falls, major adverse cardiovascular events and mental impairment disorders were reported with enzalutamide compared to placebo.…”