From the Guidelines
Apalutamide has not been definitively established as a direct cause of cardiomyopathy, and its use is not commonly associated with this condition. While cardiovascular effects can occur with apalutamide therapy, cardiomyopathy specifically is not listed among its common or well-documented adverse effects 1. Apalutamide (brand name Erleada) is an androgen receptor inhibitor primarily used to treat prostate cancer. The most common cardiovascular side effects associated with apalutamide include hypertension, ischemic heart disease, and cardiac arrhythmias rather than cardiomyopathy 1.
Key Points to Consider
- Patients with pre-existing cardiovascular disease should be monitored closely while on this medication.
- If a patient on apalutamide experiences symptoms such as unusual fatigue, shortness of breath, chest pain, or irregular heartbeat, they should seek medical attention promptly as these could indicate cardiovascular complications.
- The mechanism behind apalutamide's cardiovascular effects likely relates to its hormonal actions, as androgen deprivation can affect cardiac function and metabolism, but direct cardiotoxicity leading to cardiomyopathy is not a characteristic feature of this medication 1.
- Recent studies, including the TITAN trial, have shown that apalutamide improves radiographic progression-free survival and overall survival in patients with metastatic, castration-sensitive prostate cancer, without specifically highlighting cardiomyopathy as a common adverse effect 1.
Clinical Implications
- The benefits of apalutamide in treating prostate cancer, particularly in improving survival and delaying disease progression, should be weighed against the potential cardiovascular risks.
- Close monitoring and management of cardiovascular health are essential for patients on apalutamide, especially those with pre-existing cardiovascular conditions.
- Healthcare providers should be aware of the potential for cardiovascular side effects and take appropriate measures to mitigate these risks while maximizing the therapeutic benefits of apalutamide for patients with prostate cancer 1.
From the Research
Cardiomyopathy Risk with Apalutamide
- The risk of cardiomyopathy associated with apalutamide (Erleada) is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, a study published in 2021 2 investigated the risk of cardiovascular toxicities and hypertension in nonmetastatic castration-resistant prostate cancer patients treated with novel hormonal agents, including apalutamide.
- The study found that the addition of novel hormonal agents, such as apalutamide, was associated with a significantly increased risk of cardiovascular events (RR = 1.71; 95% CI 1.29-2.27) and grade 3-4 hypertension (RR = 1.53; 95% CI 1.19-1.97) 2.
- While this study suggests an increased risk of cardiovascular events, it does not specifically address the risk of cardiomyopathy.
- The other studies provided 3, 4, 5, 6 focus on the efficacy and safety of apalutamide in various prostate cancer settings, but do not mention cardiomyopathy as a potential side effect.
- Therefore, based on the available evidence, it is unclear whether apalutamide causes cardiomyopathy, and further research is needed to fully understand its cardiovascular risks.