Apalutamide plus androgen deprivation therapy (ADT) is recommended as an option for treating hormone-sensitive metastatic prostate cancer in adults, only if:
docetaxel is not suitable
the company provides apalutamide according to the commercial arrangement
NICE state (2):
Apalutamide plus androgen deprivation therapy (ADT) is recommended, within its marketing authorisation, as an option for treating hormone-relapsed non-metastatic prostate cancer that is at high risk of metastasising in adults. High risk is defined as a blood prostate-specific antigen (PSA) level that has doubled in 10 months or less on continuous ADT
Notes:
Apalutamide is a AR (androgen receptor) inhibitor that was discovered using a structure-activity relationship-guided medicinal chemistry approach designed to find more potent antiandrogens that retain full antagonist activity with no significant agonistic activity in the setting of increased AR expression
Apalutamide binds directly to the ligand-binding domain of the AR, and thereby prevents AR nuclear translocation, inhibits DNA binding, and impedes AR-mediated transcription.
Apalutamide selectively blocks androgen signaling to decrease tumor cell proliferation and increase cell death, leading to potent antitumor activity in preclinical prostate cancer models
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