From the Guidelines
The most effective approach to manage metastatic prostate cancer with a history of aggressive disease is to use combination therapy with androgen deprivation therapy (ADT) plus apalutamide, as this has been shown to improve overall survival and control cancer growth. For a patient who has had 18 months of ADT following surgery and radiation, and 2 years later found to have high-volume aggressive metastatic prostate cancer, the use of ADT with treatment intensification is strongly recommended 1. The addition of apalutamide to ADT is a category 1, preferred option for patients with metastatic castration-sensitive prostate cancer, as it has been shown to improve overall survival and delay disease progression 1.
The duration of control of the cancer with ADT plus apalutamide can vary depending on several factors, including the patient's performance status, comorbidities, disease burden, and prior therapies. However, clinical trials have shown that this combination can provide significant benefits in terms of overall survival and quality of life 1. Regular monitoring with PSA testing every 3 months, imaging as clinically indicated, and assessment for treatment-related side effects is essential to adjust treatment based on response and tolerability.
Key considerations in the management of metastatic prostate cancer include:
- The use of ADT with treatment intensification, such as the addition of apalutamide, for patients with metastatic castration-sensitive prostate cancer 1
- The importance of regular monitoring and assessment for treatment-related side effects 1
- The consideration of additional options, such as radium-223 for bone-predominant disease or PARP inhibitors for those with specific genetic mutations, as part of a multimodal approach to manage the disease.
In terms of the likelihood of ADT plus apalutamide controlling the cancer, clinical trials have shown that this combination can provide significant benefits in terms of overall survival and delay disease progression 1. However, the exact duration of control can vary depending on individual patient factors, and regular monitoring and adjustment of treatment are essential to optimize outcomes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Approach for Metastatic Prostate Cancer
The patient's history of aggressive disease and high-volume metastatic prostate cancer suggests the need for an effective treatment approach.
- The addition of apalutamide to androgen-deprivation therapy (ADT) has been shown to improve overall survival and radiographic progression-free survival in patients with metastatic castration-sensitive prostate cancer (mCSPC) 2, 3, 4.
- Studies have demonstrated that apalutamide plus ADT can reduce the risk of death by 35% and delay second progression-free survival and castration resistance 3.
- The treatment approach should be tailored to each patient, considering the diversity in biological and clinical features of mCSPC 5.
Efficacy and Safety of Apalutamide
- Apalutamide has been shown to be effective in improving overall survival and radiographic progression-free survival in patients with mCSPC, with a median treatment duration of 39.3 months 3.
- The safety profile of apalutamide is consistent with previous reports, with fatigue being the most frequently reported adverse event 6.
- The frequency of grade 3 or 4 adverse events was similar between the apalutamide and placebo groups, with rash being more common in the apalutamide group 4.
Duration of Treatment
- The median treatment duration of apalutamide was 39.3 months, with a median follow-up of 44.0 months 3.
- The treatment duration and follow-up period suggest that apalutamide can be effective for an extended period, but the optimal duration of treatment is not clearly defined.
- Further studies are needed to determine the optimal treatment duration and to identify biomarkers that can predict treatment response and resistance 5.