Additional Insights: Androgen Receptor Inhibitor Adverse Events

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Leanne Schimke, CRNP, CUNP:The adverse effects for these drugs: All of them are associated with a little bit of fatigue, no matter which one it is. Darolutamide may have a bit less, but in the real world, it’s hard to say if that really is going to make a difference. They all have the risk of hot flashes in men, which men do not like. They all have the risk of hypertension, headache. Some of the unusual things that each one has: All of them have a risk of rash, although in the research we saw a little bit more with apalutamide, and it was brought out that it usually occurred around the 83rd day as the median. We could treat it with steroids, topical steroids, antihistamines. Very few of them had to have prednisone or anything oral for the rash.

The other thing with apalutamide is that we have to watch for hypothyroidism. For patients who already have it, they may have to get their medications adjusted. For patients who don’t have it, you need to be watching for it because we may be attributing their fatigue to the drug when, actually, their thyroid is underactive. So those are some of the differences between the different drugs that you have to be aware of.

Some other differences include laboratory values that you may see change. With darolutamide, you may see an increase in the AST [aspartate aminotransferase] and bilirubin levels, and you may see a bit of a decrease in the neutrophil count.

With apalutamide, you might also see some elevation in their triglycerides, in addition to, sometimes, a lower white blood cell count.

With enzalutamide, you may see an increase in some of the lab values. You may see an increase in their glucose levels. You can see an increase in their magnesium levels. You may have some hyponatremia. You may also see some decrease in their neutrophil count.

Transcript edited for clarity.