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Benefits of Using Erleada with Concurrent Radiotherapy

Benefits of Using Erleada with Concurrent Radiotherapy

Prostate cancer is a complex and challenging condition that requires a multi-faceted approach to treatment. Among the advancements in managing this disease is the use of Erleada (apalutamide) in combination with concurrent radiotherapy. This innovative approach has shown promising results in both non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC).

Let’s delve deeper into the benefits and implications of incorporating Erleada with concurrent radiotherapy to better understand its impact on patient outcomes.

Concurrent Radiotherapy and Systemic Agents

Erleada (generic name: apalutamide) is a medication used in the treatment of prostate cancer. Let’s explore its use in combination with concurrent radiotherapy.

  1. Erleada and Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC):

    • In patients with non-metastatic castration-resistant prostate cancer (nmCRPC) who are at high risk of developing metastases, Erleada has shown significant benefits.
    • The SPARTAN study demonstrated that when Erleada was combined with androgen deprivation therapy (ADT), it significantly improved overall survival (OS) compared to ADT alone.
    • The median OS was 73.9 months for patients receiving Erleada + ADT, compared to 59.9 months for patients receiving placebo + ADT.
    • The risk of death was reduced by 22% with Erleada .
    • Despite a crossover of 76 randomized placebo patients (19%) to Erleada after the study met its primary endpoint of metastasis-free survival (MFS), the treatment effect of Erleada + ADT still exceeded median OS compared to placebo + ADT .
    • Additionally, Erleada + ADT significantly delayed patients’ time to cytotoxic chemotherapy compared to placebo + ADT .
  2. Concurrent Radiotherapy and Systemic Agents:

    • Radiotherapy impacts the cancer cell cycle, causing DNA double-strand breaks that lead to cell death.
    • Erleada is a systemic agent that can either enhance or inhibit radiation effects.
    • The relevant clinical questions include:
      • Is concurrent treatment better than either modality alone?
      • Are recurrence rates higher when treatments are combined?
      • Are toxicities exacerbated when administered concurrently?
      • What is more practical: concurrent or sequential radiation and systemic therapy?
    • Tamoxifen, an older drug, inhibits cell proliferation by halting cells in the G1 phase. It could potentially inhibit radiation efficacy, which is most effective in the G2 and M phases .
    • Caution is needed when combining Erleada with medications metabolized by CYP3A4, CYP2C19, or CYP2C9, as it can result in lower exposure to these medications .
  3. Metastatic Castration-Sensitive Prostate Cancer (mCSPC):

    • Erleada has also been approved for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC) based on results from the TITAN study.
    • In this study, Erleada + ADT achieved statistical significance in the dual primary endpoints of overall survival (OS) and radiographic progression-free survival (rPFS) .

In summary, Erleada

Benefits of Erleada in Combination with Concurrent Radiotherapy

Let’s explore the benefits of Erleada in combination with concurrent radiotherapy:

  1. Erleada in Prostate Cancer:

    • Erleada (apalutamide) is a medication used in the treatment of prostate cancer.
    • In the TITAN trial, which involved 525 men treated with Erleada plus continuous androgen deprivation therapy (ADT) compared to 527 men treated with ADT alone, the addition of Erleada conferred a 52% reduction in the risk of death or radiographic progression.
    • At the 2-year mark, results showed an absolute 20 percentage point difference in the rate of cancer progression in favor of Erleada.
  2. Erleada in Cervical Cancer:

    • In a phase II study, researchers evaluated the feasibility of incorporating intensity-modulated radiotherapy (IMRT) and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment of high-risk locally advanced cervical cancer.
    • The study included patients with biopsy-proven stage IIIA-IVA squamous cervical cancer or stage IIB disease with metastatic regional nodes.
    • The treatment protocol involved concurrent weekly intravenous cisplatin during external-beam radiotherapy, followed by adjuvant chemotherapy.
    • After a median follow-up period of 66 months, loco-regional control was achieved, and the treatment protocol demonstrated promising outcomes.

A schematic overview of the core programme and the radiotherapy programme, and their potential interactions with regulatory authorities.

IMG Source: springernature.com


Erleada Side Effects and Precautions

Erleada (apalutamide) is a prescription oral tablet used to treat certain types of prostate cancer. It can cause side effects that range from mild to serious. Let’s explore these side effects and precautions:

  1. Common Side Effects:

    • Fatigue (low energy): Some people may experience tiredness while taking Erleada.
    • Joint Pain: Joint discomfort or pain is a commonly reported side effect.
    • Skin Rash: Skin reactions, such as rashes, may occur.
    • Appetite Loss and Weight Loss: Changes in appetite and weight loss are possible.
  2. Mild Side Effects:

    • Diarrhea: Some individuals may experience diarrhea.
    • Flushing: A sensation of warmth or redness in the skin.
    • Itchiness: Skin itching may occur.
    • Muscle Spasms: Unintentional muscle contractions.
    • Nausea: Feeling queasy or nauseated.
    • Swelling: Swelling in hands, feet, genitals, or lymph nodes.
    • Mild Allergic Reaction: In most cases, these side effects should be temporary and manageable.
  3. Serious Side Effects:

    • Heart-Related Side Effects: Rare but important. If you experience chest pain or other heart-related symptoms, seek medical attention promptly.
    • Stroke or Mini-Stroke: Uncommon but serious.
    • Bone Fracture: Erleada treatment can weaken bones and muscles, increasing the risk of fractures.
    • Seizures: Treatment with Erleada may increase the risk of seizures.
    • Severe Allergic Reaction: Including life-threatening skin reactions.

If you develop serious side effects while taking Erleada, contact your doctor immediately. Remember, always follow your doctor’s recommendations and do not stop taking Erleada without their guidance.

A list of the possible side effects of radiation therapy, including diarrhea, hair loss, mouth problems, and nausea.

IMG Source: actchealth.com


Radiation Therapy Overview

Radiation Therapy (also known as radiotherapy) is a powerful treatment that employs high doses of radiation to destroy cancer cells and shrink tumors. Let’s delve into the details:

  1. How Does Radiation Therapy Work?

    • Radiation therapy damages cancer cells’ DNA, causing them to stop dividing and eventually die. The body then eliminates these damaged cells over days or weeks after treatment.
    • The actual radiation process is relatively short, with most of the appointment spent positioning the body correctly.
  2. Types of Radiation Therapy:

    • External Beam Radiation Therapy (EBRT):
      • 3-Dimensional Conformal Radiation Therapy (3D-CRT): Utilizes 3D images (from CT or MRI) to precisely target the tumor.
      • Intensity-Modulated Radiation Therapy (IMRT): Adjusts radiation levels in each beam to minimize side effects.
      • Stereotactic Body Radiation Therapy (SBRT) or Stereotactic Ablative Radiation Therapy (SABR): Potentially more powerful in destroying cancer cells, often delivered in fewer treatments.
    • Internal Radiation (Brachytherapy):
      • Commonly used for head and neck, breast, cervix, prostate, and eye cancers.
  3. Patient Experiences:

    • The Patient Story community shares their radiation therapy journeys, providing insights into the process, side effects, and outcomes.
    • Some patients opt for clinical trials to explore innovative approaches, like those using Erleada (apalutamide) for castration-resistant metastasis-free prostate cancer.
    • High-quality treatment can significantly impact patients’ lives, allowing them to lead regular lives even during therapy.

A purple and white box of Erleada tablets, a medication used to treat prostate cancer.

IMG Source: squarespace.com


Advancements in Erleada

Let’s delve into the advancements related to Erleada

  1. ERLEADA® (Apalutamide) in Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC):

    • The SPARTAN study demonstrated that Erleada combined with androgen deprivation therapy (ADT) significantly improved overall survival (OS) compared to ADT alone in patients with high-risk nmCRPC who were at risk of developing metastases.
    • The median OS was 73.9 months for patients receiving Erleada + ADT, compared to 59.9 months for those receiving placebo + ADT. This improvement was achieved despite a crossover of placebo patients to Erleada treatment.
    • Additionally, Erleada + ADT significantly delayed patients’ time to cytotoxic chemotherapy compared to placebo + ADT.
  2. Erleada in Metastatic Castration-Sensitive Prostate Cancer (mCSPC):

    • Real-world evidence data showed that the initiation of Erleada resulted in high rates of rapid and deep prostate-specific antigen (PSA) response among patients with metastatic castration-sensitive prostate cancer (mCSPC).
  3. TITAN Study:

    • The TITAN study demonstrated the continued statistically significant benefit of adding Erleada to ADT in overall survival (OS) in patients with metastatic castration-sensitive prostate cancer.
    • The addition of Erleada to ADT conferred a 52% reduction in risk for death or radiographic progression. At 2 years, the overall survival rate was 82% for Erleada compared to 74% for ADT alone.
  4. Erleada in Non-Metastatic Castration-Resistant Prostate Cancer (NM-CRPC):

    • The risk of distant metastasis or death decreased by 72% in patients treated with Erleada compared with placebo.
    • Median metastasis-free survival (MFS) was improved by more than two years in NM-CRPC patients with rising PSA, compared with placebo.

These advancements highlight the potential of Erleada

A diagram showing the cell cycle and the phases in which different classes of anticancer drugs are effective.

IMG Source: mdpi.com



In conclusion, the integration of Erleada with concurrent radiotherapy represents a significant advancement in the treatment landscape of prostate cancer, particularly in non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC). The synergy between Erleada and radiotherapy offers a comprehensive approach to targeting cancer cells and improving patient outcomes. With ongoing research and real-world evidence supporting the efficacy of this combination therapy, the future looks promising for individuals battling prostate cancer.

By staying informed and embracing innovative treatment modalities like Erleada with concurrent radiotherapy, clinicians and patients can navigate the complexities of prostate cancer with greater confidence and optimism.

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