Erlada (Apalutamide) Usage and Side Effects
Erlada (apalutamide) is an oral non-steroidal androgen receptor inhibitor primarily used for treating prostate cancer, specifically non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC).
Mechanism of Action
- Apalutamide binds directly to the ligand-binding domain of the androgen receptor and blocks the effects of androgens 1
- It is typically administered as an adjunct to androgen deprivation therapy (ADT) 2
Proper Usage
Dosage and Administration
- Standard dose: 240 mg (four 60 mg tablets) taken orally once daily 3
- Should be taken with or without food
- For patients undergoing surgery, consider stopping at least one week before elective procedures
Indications
Non-metastatic castration-resistant prostate cancer (nmCRPC)
- Particularly in patients with high risk of developing metastatic disease
- Used in combination with ongoing androgen deprivation therapy 1
Metastatic castration-sensitive prostate cancer (mCSPC)
- Used in combination with androgen deprivation therapy 2
Potential Side Effects
Common Side Effects
Serious Side Effects
- Seizures (rare)
- Falls and fractures
- Cardiovascular events
- Severe skin reactions
Monitoring Requirements
- Regular follow-up to assess:
- Treatment efficacy (PSA levels, imaging)
- Side effect burden
- Blood pressure
- Liver function tests
Special Considerations
Drug Interactions
- Potential interactions with concomitant medications should be evaluated 4
- May affect metabolism of other drugs processed through the liver
Contraindications
- Pregnancy or women who may become pregnant
- Severe hepatic impairment
- Known hypersensitivity to apalutamide or any component of the formulation
Clinical Benefits
- In nmCRPC: Significantly prolonged metastasis-free survival compared to placebo 1
- In mCSPC: Improved radiographic progression-free survival and overall survival 2
- Maintains health-related quality of life while on treatment 1, 2
Important Precautions
- Monitor for falls and fractures, especially in elderly patients
- Watch for signs of seizures, particularly in patients with predisposing factors
- Regular monitoring of blood pressure is recommended
- Assess for skin reactions, which may require dose modification or discontinuation
Management of Side Effects
- For rash: Topical corticosteroids and antihistamines may help
- For fatigue: Activity pacing and regular exercise as tolerated
- For hypertension: Standard antihypertensive therapy
- For hot flushes: Lifestyle modifications and potentially additional symptomatic treatments
Erlada represents an important treatment option for men with specific types of prostate cancer, with clinical trials demonstrating significant benefits in delaying disease progression while maintaining quality of life.