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Suzuki K, Shiraishi Y, Furukawa J, Okamura Y, Bando Y, Hara T, Okada K, Terakawa T, Hyodo Y, Chiba K, Teishima J, Nakano Y, Miyake H. Clinical Outcomes and Risk Stratification in Patients With Metastatic Hormone-Sensitive Prostate Cancer Treated With New-Generation Androgen Receptor Signaling Inhibitors. Clin Genitourin Cancer 2024; 22:102140. [PMID: 39018723 DOI: 10.1016/j.clgc.2024.102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Optimal drug selection for metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We therefore assessed the clinical outcomes of mHSPC treated with new-generation androgen receptor pathway inhibitors (ARSIs) and identified risk factors associated with the prognosis of mHSPC. METHODS We retrospectively reviewed 324 patients with mHSPC who were treated with ARSIs, including abiraterone acetate, enzalutamide, and apalutamide, between January 2018 and December 2022. In addition to assessing the prostate-specific antigen (PSA) response and overall survival (OS) during ARSI treatment, we investigated several potential risk factors for a poor OS in patients with mHSPC. RESULTS Patients with a ≥ 90% PSA reduction (hazard ratio [HR]: 0.24, 95% confidence interval [CI], 0.10-0.58; P = .002) and those whose PSA declined to ≤ 0.2 ng/mL (HR: 0.22, 95% CI, 0.08-0.63; P = .005) showed significantly better OS than other patients. Gleason grade group 5 (GG5), presence of liver metastasis, and an LDH ≥ 250 U/L were identified as prognostic factors significantly associated with a poor OS, with HRs of 2.31 (95% CI, 1.02-5.20; P = .044), 7.87 (95% CI, 2.61-23.8; P < .001) and 3.21 (95% CI, 1.43-7.23; P = .005). CONCLUSION We identified GG5, the presence of liver metastasis, and elevated LDH at the diagnosis as significant factors predicting the OS of mHSPC, but the choice of ARSIs did not affect the prognosis. The potential prognostic impact of these markers requires further investigation.
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Affiliation(s)
- Kotaro Suzuki
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yusuke Shiraishi
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyoshi Okamura
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukari Bando
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuto Hara
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Okada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoji Hyodo
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Chiba
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Teishima
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuzo Nakano
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Gil-Lianes J, Amat-Samaranch V, Giavedoni P, Vilaseca A, Córdoba Sánchez J, Alamon-Reig F, Castillo P, Garcia AP, Pascal M, Carrera C. Cutaneous Adverse Reactions to Apalutamide: Case Series with Clinical and Pathological Correlations. Acta Derm Venereol 2024; 104:adv40719. [PMID: 39233615 PMCID: PMC11382552 DOI: 10.2340/actadv.v104.40719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Javier Gil-Lianes
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Victoria Amat-Samaranch
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; Pharmacovigilance program, Hospital Clínic Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Antoni Vilaseca
- Pharmacovigilance program, Hospital Clínic Barcelona, Barcelona, Spain; Department of Urology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Adriana P Garcia
- Department of Pathology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Pharmacovigilance program, Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Department of Dermatology, Hospital Clínic Barcelona, University of Barcelona, Spain; Pharmacovigilance program, Hospital Clínic Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras CIBERER, Instituto Salud Carlos III, Spain.
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Huang PC, Huang LH, Yang CK, Li JR, Chen CS, Wang SS, Chiu KY, Ou YC, Lin CY. Comparative analysis of novel hormonal agents in non-metastatic castration-resistant prostate cancer: A Taiwanese perspective. PLoS One 2024; 19:e0306900. [PMID: 39110673 PMCID: PMC11305548 DOI: 10.1371/journal.pone.0306900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Non-metastatic castration-resistant prostate cancer (nmCRPC) is an asymptomatic condition with the potential to progress to metastasis. Novel hormonal agents (NHAs) are currently considered the gold standard treatment for nmCRPC, offering significant survival benefits. However, further evidence is needed to determine whether there are differences in the performance of these drugs among Asian populations. METHODS This retrospective analysis of nmCRPC patients aims to compare the efficacy and safety of three NHAs-apalutamide, darolutamide, and enzalutamide. Data were collected from two prominent prostate care centers in Taichung, Taiwan. Patient characteristics, treatment details, PSA responses, and adverse events were analyzed. Statistical comparisons were performed, and the study received Institutional Review Board approval. RESULTS Total of 64 patients were recruited in this study, including 29 darolutamide, 26 apalutamide, and 9 enzalutamide patients. Baseline characteristics varied between the three patient groups, but the treatment response still revealed similar results. The apalutamide group experienced more adverse events, notably skin rash. Discontinuation rates due to adverse events differed among the groups, and patients receiving darolutamide were less likely to discontinue treatment. CONCLUSION This real-world study provides insights into NHA utilization in nmCRPC within the Taiwanese population. Adverse event profiles varied, emphasizing the need for individualized treatment decisions. The study underscores the importance of regional considerations and contributes valuable data for optimizing treatment outcomes in nmCRPC.
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Affiliation(s)
- Po-Chieh Huang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Hua Huang
- Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Chuan-Shu Chen
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shian-Shiang Wang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Kun-Yuan Chiu
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Chia-Yen Lin
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Marx G, Chowdhury S, Krieger L, Hovey E, Shapiro J, Tran B, Tan TH, Ng S, Woo HH. A practical guide for the use of apalutamide for non-metastatic castration-resistant prostate cancer in Australia. Asia Pac J Clin Oncol 2024; 20:435-443. [PMID: 38639402 DOI: 10.1111/ajco.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/01/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
Studies of patients with castrate-resistant prostate cancer at high risk of developing overt metastases but with no current evidence of evaluable disease on computed tomography or bone scan non-metastatic castrate-resistant prostrate cancer have demonstrated increased metastasis-free survival and overall survival following treatment with the next-generation oral anti-androgen apalutamide (in addition to therapies that aim to lower testosterone to castrate levels) or luteinizing hormone-releasing hormone antagonist or surgical castration. Patients receiving apalutamide can be managed by medical oncologists, radiation oncologists, or urologists, preferably as part of a multidisciplinary team. However, the importance of additional safety monitoring for significant adverse effects and drug interactions should not be underestimated. The toxicities of apalutamide are manageable with experience and should be managed proactively to minimize their impact on patients. Monitoring of patients for apalutamide-specific toxicities, including skin rash, hypothyroidism, and QT prolongation should be carried out regularly, particularly in the first few months following initiation. Monitoring should continue alongside monitoring for toxicities of androgen deprivation, including cardiovascular risk, hot flashes, weight gain, bone health, muscle wasting, and diabetic risk. This review is a practical guide to the use of apalutamide describing the management of patients including dosing and administration, toxicities, potential drug interactions, and safety monitoring requirements.
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Affiliation(s)
- Gavin Marx
- San Clinical Trial Unit, Sydney Adventist Hospital, Integrated Cancer Centre, Wahroonga, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | | | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
- University of New South Wales, Sydney, Australia
| | - Jeremy Shapiro
- Department of Medical Oncology, Cabrini Haematology and Oncology Centre, Malvern, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Thean Hsiang Tan
- Department of Medical Oncology, Royal Adelaide Hospital, Adelaide and Icon Cancer Centre, Adelaide, Australia
| | - Siobhan Ng
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Henry H Woo
- San Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, Australia
- Department of Uro-Oncology, Chris O'Brien Lifehouse, Camperdown, Australia
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Kohjimoto Y, Uemura H, Yoshida M, Hinotsu S, Takahashi S, Takeuchi T, Suzuki K, Shinmoto H, Tamada T, Inoue T, Sugimoto M, Takenaka A, Habuchi T, Ishikawa H, Mizowaki T, Saito S, Miyake H, Matsubara N, Nonomura N, Sakai H, Ito A, Ukimura O, Matsuyama H, Hara I. Japanese clinical practice guidelines for prostate cancer 2023. Int J Urol 2024. [PMID: 39078210 DOI: 10.1111/iju.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.
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Affiliation(s)
- Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of EBM and Guidelines, Japan Council for Quality Health Care (Minds), Tokyo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- NPO Prostate Cancer Patients Association, Takarazuka, Hyogo, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Tochigi, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Saito
- Department of Urology, Prostate Cancer Center Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Rosai Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
- Department of Urology, JA Yamaguchi Kouseiren Nagato General Hospital, Yamaguchi, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Shore N, Hafron J, Saltzstein D, Bhaumik A, Aggarwal P, Phillips J, McGowan T. Impact of a rash management guide in patients receiving apalutamide for high-risk localized prostate cancer in the Apa-RP study. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00858-4. [PMID: 38969791 DOI: 10.1038/s41391-024-00858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND/OBJECTIVES Based on the SPARTAN and TITAN studies, apalutamide is approved for patients with nonmetastatic castration-resistant and metastatic castration-sensitive prostate cancer. Skin rash was a common adverse reaction across indications. We hypothesized that earlier identification and intervention could improve rash outcomes. SUBJECTS/METHODS A prespecified rash management guide outlining recommended skin care practices was provided to all patients enrolled in Apa-RP (NCT04523207). Rash-related safety data from Apa-RP were compared descriptively with data from SPARTAN and TITAN. RESULTS Patients in Apa-RP experienced improved rash-related outcomes vs those in SPARTAN and TITAN. CONCLUSIONS Increased vigilance and proactive management may reduce the incidence, severity, and duration of rash during apalutamide treatment.
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Affiliation(s)
- Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA.
| | - Jason Hafron
- Michigan Institute of Urology, West Bloomfield, MI, USA
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Ciolfi C, Lunardon A, Cassalia F, Alaibac M. Apalutamide-induced ichthyosiform eruption. Dermatol Reports 2024; 16:9734. [PMID: 38957639 PMCID: PMC11216133 DOI: 10.4081/dr.2023.9734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2024] Open
Abstract
Not available
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Affiliation(s)
| | | | | | - Mauro Alaibac
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Italy
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Yang Z, Shao Y, Huang H, Liu Y, Wang Z, Wang Y. Real-world analysis of apalutamide-associated skin rash in Chinese patients with prostate cancer. World J Urol 2024; 42:171. [PMID: 38506974 DOI: 10.1007/s00345-024-04880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE This study aimed to explore the clinical characteristics of apalutamide-associated skin rash and management of skin rash in real-world Chinese patients with prostate cancer. METHODS We investigated 138 patients with prostate cancer who received apalutamide in the Second Hospital of Tianjin Medical University from January 2022 to March 2023. The primary end points were the incidence of skin rash and the time to skin rash. The second end points were the grade of skin rash, the time to remission, the rate of recurrence of skin rash, clinical risk factors and management of skin rash. RESULTS One hundred patients were analyzed. Patients were a median of 73 years old (IQR 68-77.75). Thirty-two patients (32%) developed apalutamide‑associated skin rash. The median time to incidence and remission of skin rash were 57.5 and 11.5 days, respectively. Of 32 skin rash, 27 patients had apalutamide therapy maintained after rash remission. There were seven patients having recurrence of skin rash. By multivariable logistic regression analysis, we revealed that hypertension history (OR 3.22, 95% CI 1.09-9.53, p = 0.035), bad life-styles (OR 3.29, 95% CI 1.11-9.8, p = 0.032), ECOG ≥ 1 (OR 3.92, 95% CI 1.33-11.55, p = 0.013), and high tumor burden (OR 3.13, 95% CI 1.07-9.14, p = 0.037) were independently associated with higher incidence of skin rash. CONCLUSION Nearly one-third of Chinese patients experienced skin rash after taking apalutamide in our study. The poor health patients might have a higher incidence of apalutamide-associated skin rash.
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Affiliation(s)
- Zhen Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuan Shao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hua Huang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zeyuan Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
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Tohi Y, Kato T, Kobayashi K, Daizumoto K, Fukuhara H, Ohira S, Katayama S, Shimizu R, Takamoto A, Nishimura K, Ikeda K, Nagami T, Hayashida Y, Hirama H, Naito H, Tomida R, Sasaki Y, Yamamoto S, Shimizu S, Sugimoto M. Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium. Jpn J Clin Oncol 2024; 54:167-174. [PMID: 37840362 DOI: 10.1093/jjco/hyad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC). METHODS We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide. RESULTS PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients. CONCLUSIONS Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.
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Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa
| | - Keita Kobayashi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima
| | - Hideo Fukuhara
- Department of Urology, Kochi Medical School, Nankoku, Kochi
| | - Shin Ohira
- Department of Urology, Kawasaki Medical School, Okayama
| | - Satoshi Katayama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori
| | | | | | - Kenichiro Ikeda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Taichi Nagami
- Department of Urology, Shimane University, Faculty of Medicine, Izumo, Shimane
| | - Yushi Hayashida
- Department of Urology, Sakaide City Hospital, Sakaide, Kagawa
| | - Hiromi Hirama
- Department of Urology, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
| | - Hirohito Naito
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima
| | - Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima
| | | | | | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa
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10
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Wang Q, Cao H, Zhang X, Wu H, Tang Z. Case report: Apalutamide-induced severe lethal cutaneous adverse effects in China. Front Immunol 2024; 14:1291564. [PMID: 38274795 PMCID: PMC10808516 DOI: 10.3389/fimmu.2023.1291564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Apalutamide is a novel agent for castration-resistant prostate cancer while skin rashes are the most common untoward reactions. Up to now, most of the reported dermatologic adverse events (dAEs) allocated to mild and moderate with a fair prognosis. Herein, we report a case series of severe dAEs in China caused by apalutamide. Case presentation The four patients all developed severe and lethal drug eruptions including Stevens-Johnson syndrome and toxic epidermal necrolysis with a mean incubation period of 40 days. On the basis of the medical condition, all the patients were suggested to withdraw apalutamide and three of them recovered. Of note, attempts of rechallenges of apalutamide may be fatal. Discussion The incidence of dAEs in previously conducted clinical trials exceeded 20%, with maculopapular rashes being the most common feature. However, the incidence and severity varied in different geographic regions and ethnicities. Inadequate attention was paid to severe cutaneous adverse reactions. Long latency may easily lead to the misdiagnosis of dAEs, and immediate withdrawal of apalutamide is the cornerstone of therapies. Conclusion Special and adequate attention should be paid to apalutamide-attributed severe cutaneous adverse effects. Besides, the prognosis of severe drug eruptions may be disappointing, and in-time withdrawal is vital.
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Affiliation(s)
- Qi Wang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- Department of Dermatology, Changxing People’s Hospital, Huzhou, China
| | - Huali Cao
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xuetong Zhang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Huifeng Wu
- Department of Urology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuangli Tang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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11
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Guglielmini PF, Massone C, Grasso C, Francese A, Vincenti M, Chiodi S, Rossi M, Maconi A. A rare and severe lichenoid skin eruption after apalutamide treatment for prostate cancer. Ann Dermatol Venereol 2023; 150:310-311. [PMID: 37903707 DOI: 10.1016/j.annder.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 11/01/2023]
Affiliation(s)
- P-F Guglielmini
- Oncology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - C Massone
- Dermatology Unit & Scientific Directorate, Galliera Hospital, Genoa, Italy
| | - C Grasso
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy
| | - A Francese
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy.
| | - M Vincenti
- Oncology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - S Chiodi
- Plastic Surgery, Galliera Hospital, 16128 Genoa, Italy
| | - M Rossi
- Oncology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - A Maconi
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy
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12
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Chung BH, Huang J, Uemura H, Choi YD, Ye ZQ, Suzuki H, Kang TW, He DL, Joung JY, Brookman-May SD, McCarthy S, Bhaumik A, Singh A, Mundle S, Chowdhury S, Agarwal N, Ye DW, Chi KN, Uemura H. Apalutamide for metastatic castration-sensitive prostate cancer: final analysis of the Asian subpopulation in the TITAN trial. Asian J Androl 2023; 25:653-661. [PMID: 37322621 DOI: 10.4103/aja202320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
The final analysis of the phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen (TITAN) trial showed improvement in overall survival (OS) and other efficacy endpoints with apalutamide plus androgen deprivation therapy (ADT) versus ADT alone in patients with metastatic castration-sensitive prostate cancer (mCSPC). As ethnicity and regional differences may affect treatment outcomes in advanced prostate cancer, a post hoc final analysis was conducted to assess the efficacy and safety of apalutamide in the Asian subpopulation. Event-driven endpoints were OS, and time from randomization to initiation of castration resistance, prostate-specific antigen (PSA) progression, and second progression-free survival (PFS2) on first subsequent therapy or death. Efficacy endpoints were assessed using the Kaplan-Meier method and Cox proportional-hazards models without formal statistical testing and adjustment for multiplicity. Participating Asian patients received once-daily apalutamide 240 mg ( n = 111) or placebo ( n = 110) plus ADT. After a median follow-up of 42.5 months and despite crossover of 47 placebo recipients to open-label apalutamide, apalutamide reduced the risk of death by 32% (hazard ratio [HR]: 0.68; 95% confidence interval [CI]: 0.42-1.13), risk of castration resistance by 69% (HR: 0.31; 95% CI: 0.21-0.46), PSA progression by 79% (HR: 0.21; 95% CI: 0.13-0.35) and PFS2 by 24% (HR: 0.76; 95% CI: 0.44-1.29) relative to placebo. The outcomes were comparable between subgroups with low- and high-volume disease at baseline. No new safety issues were identified. Apalutamide provides valuable clinical benefits to Asian patients with mCSPC, with an efficacy and safety profile consistent with that in the overall patient population.
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Affiliation(s)
- Byung Ha Chung
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jian Huang
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510123, China
| | - Hiroji Uemura
- Yokohama City University Medical Center, Minami-ku, Yokohama, Kanagwa 232-0024, Japan
| | - Young Deuk Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Zhang-Qun Ye
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | | | - Taek Won Kang
- Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
| | - Da-Lin He
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jae Young Joung
- Prostate Cancer Center, National Cancer Center, Goyang 10408, South Korea
| | - Sabine D Brookman-May
- Janssen Research and Development, Spring House, PA 19002, USA
- Ludwig Maximilians University, Munich 80539, Germany
| | | | | | - Anildeep Singh
- Janssen Medical Affairs, Asia Pacific, Singapore 118222, Singapore
| | - Suneel Mundle
- Janssen Research and Development, Raritan, NJ 08869, USA
| | - Simon Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London SE1 4YB, UK
| | - Neeraj Agarwal
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Kim N Chi
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia V6H 3Z6, Canada
| | - Hirotsugu Uemura
- Kindai University, Faculty of Medicine, Osaka-Sayama 589-8511, Japan
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13
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Cremante M, Puglisi S, Gandini A, Guadagno A, Catalano F, Damassi A, Murianni V, Llaja Obispo MA, Banna GL, Buti S, Rebuzzi SE, Rescigno P, Fornarini G. Apalutamide-induced lichenoid reaction in a patient with non-metastatic castrate-resistant prostate cancer. J Oncol Pharm Pract 2023; 29:1748-1753. [PMID: 37282554 DOI: 10.1177/10781552231180598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Apalutamide is an oral selective androgen receptor inhibitor, approved by the FDA for the treatment of patients with non-metastatic, castration-resistant prostate cancer (M0 CRPC) at high risk of developing metastases and for patients with metastatic castration-sensitive prostate (mHSPC) in association with androgen deprivation therapy (ADT). In the registration studies, skin reactions were reported among the most common side effects and as an adverse event of special interest. CASE REPORT Apalutamide-induced rash includes a wide spectrum of different types of skin reactions, but few cases reports and case series have described this adverse event. Here, we report an M0 CRPC patient who experienced a rare skin adverse event, a lichenoid reaction. MANAGEMENT & OUTCOME After 4 months of therapy with apalutamide, the patient reported dorsal pricking and dry skin. Lichenoid reaction was confirmed histologically and its correlation to the drug was demonstrated after pursuing a multidisciplinary approach. DISCUSSION To our knowledge, this is one of the first cases of Apalutamide-related lichenoid reaction and this clinical case showed the relevance of a multidisciplinary management when assessing drug-related adverse events. A broader knowledge of the spectrum of drug-related reactions would allow for a better diagnosis and therapy management by both physicians and patients.
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Affiliation(s)
- Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Annalice Gandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Guadagno
- Pathology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Damassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Giuseppe Luigi Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Translational Research and Clinical Trial Unit, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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14
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Fang Z, Xu Z, Zhu W, Yu M, Ji C. A real-world disproportionality analysis of apalutamide: data mining of the FDA adverse event reporting system. Front Pharmacol 2023; 14:1101861. [PMID: 37342589 PMCID: PMC10277739 DOI: 10.3389/fphar.2023.1101861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Background: Apalutamide is a new drug class, which is approved to treat prostate cancer (PCa). The aim of our study was to assess the safety profiles of apalutamide in real-world through data mining of the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Method: We included adverse event (AE) reports regarding apalutamide submitted to the FAERS from 2018 quarter 1 (2018Q1) to 2022 quarter 1 (2022Q1). Disproportionality analyses, including reporting odds ratio (ROR), were performed to identify the signals of AEs in patients receiving apalutamide. A signal was detected if the lower limit of the 95% confidence interval (CI) of ROR >1 and at least 3 AEs were reported. Results: The FAERS database documented 4,156 reports regarding apalutamide from 1 January 2018, to 31 March 2022. A total of 100 significant disproportionality preferred terms (PTs) were retained. Frequently observed AEs in patients receiving apalutamide included rash, fatigue, diarrhea, hot flush, fall, weight decreased, hypertension. The most significant system organ class (SOC) was "skin and subcutaneous tissue disorders", which mainly consisted of dermatological adverse events (dAEs). The additional AEs observed with the significantly signal contain lichenoid keratosis, increased eosinophil count, bacterial pneumonia, pulmonary tuberculosis, hydronephrosis. Conclusion: Our findings provide valuable evidence for apalutamide safety profile in the real-world, which could help clinicians and pharmacists to enhance their vigilance and improve the safety of apalutamide in clinical practice.
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Affiliation(s)
- Zhihong Fang
- Department of General Surgery, The Affiliated Wuxi Children’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhiqiang Xu
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Zhu
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingming Yu
- Department of Urology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunmei Ji
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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15
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De Moor R, Koroki Y, Wu DBC, Yu DY, Tohyama M, Ohyama C. A retrospective study on the incidence, management and risk factors of skin rash in patients with advanced prostate cancer in Japan. BMC Urol 2023; 23:73. [PMID: 37118710 PMCID: PMC10148545 DOI: 10.1186/s12894-023-01246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Worldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan. METHODS A retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash. RESULTS Overall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of < 18.5 (nmCRPC and mCRPC), and a PSA level higher than the median (nmCRPC). Skin rash was commonly managed with systemic and topical corticosteroids which ranged from 41.76% to 67.03% for all cohorts. Antihistamines were infrequently used. CONCLUSION This study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20-30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of < 18.5, increased age and higher PSA levels, and was usually treated with corticosteroids.
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Affiliation(s)
- Raf De Moor
- Integrated Market Access, Janssen Pharmaceutical K.K., 3 Chome-5-2 Nishikanda, Tokyo, 101-0065, Japan.
| | - Yosuke Koroki
- Medical Affairs, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - David Bin-Chia Wu
- Janssen Pharmaceutical Companies of Johnson and Johnson, Asia Pacific Regional Office, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- School of Pharmacy, Monash University Malaysia, Bandar Suwnay, Malaysia
| | - Dae Young Yu
- Janssen Pharmaceutical Companies of Johnson and Johnson, Asia Pacific Regional Office, Singapore, Singapore
| | - Mikiko Tohyama
- Department of Dermatology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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16
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Yang CK, Cha TL, Chang YH, Huang SP, Lin JT, Wang SS, Huang CY, Pang ST. Darolutamide for non-metastatic castration-resistant prostate cancer: Efficacy, safety, and clinical perspectives of use. J Formos Med Assoc 2023; 122:299-308. [PMID: 36797129 DOI: 10.1016/j.jfma.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/23/2022] [Accepted: 12/12/2022] [Indexed: 02/16/2023] Open
Abstract
Darolutamide, a second-generation androgen receptor inhibitor (SGARI), has been shown to increase metastasis-free survival and overall survival among men with non-metastatic castration-resistant prostate cancer (nmCRPC). Its unique chemical structure potentially provides efficacy and safety advantages over the SGARIs apalutamide and enzalutamide, which are also indicated for nmCRPC. Despite a lack of direct comparisons, the SGARIs appear to have similar efficacy, safety, and quality of life (QoL) results. Indirect evidence suggests that darolutamide is preferred for its good adverse event profile, an attribute valued by physicians, patients, and their caregivers for maintaining QoL. Darolutamide and others in its class are costly; access may be a challenge for many patients and may lead to modifications to guideline-recommended regimens.
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Affiliation(s)
- Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yen-Hwa Chang
- Division of General Urology, Department of Urology, Taipei Veterans General Hospital, Taiwan; Department of Urology, National Yang-Ming University School of Medicine, Taiwan
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan; Institute of Medicine, Chung Shan Medical University, Taiwan; Department of Applied Chemistry, National Chi Nan University, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taiwan; College of Medicine, National Taiwan University, Taiwan.
| | - See-Tong Pang
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taiwan; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
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17
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Pons Benavent M, Porcar Saura S, Bou Boluda L. [Translated article] RF-Adverse Skin Reaction to Apalutamide: An Emerging Effect. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T336-T338. [PMID: 36806633 DOI: 10.1016/j.ad.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/11/2021] [Indexed: 02/19/2023] Open
Affiliation(s)
- M Pons Benavent
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Blasco Ibéñez 17, Valencia 46010, Spain.
| | - S Porcar Saura
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Blasco Ibéñez 17, Valencia 46010, Spain
| | - L Bou Boluda
- Servicio de Dermatología, Hospital Arnau de Vilanova, San Clemente 12, Valencia 46015, Spain
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18
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Oishi T, Hatakeyama S, Tabata R, Fujimori D, Kawashima Y, Tanaka R, Ishii N, Miura H, Tanaka T, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Sato S, Ohyama C. Effects of apalutamide dose reduction on skin-related adverse events in patients with advanced prostate cancer: A multicenter retrospective study. Prostate 2023; 83:198-203. [PMID: 36314250 DOI: 10.1002/pros.24453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to evaluate the effects of apalutamide dose reduction on skin-related adverse events (AEs) and castration-resistant prostate cancer (CRPC)-free survival in patients with advanced prostate cancer (PC). METHODS We retrospectively evaluated 35 patients with nonmetastatic CRPC and 72 patients with treatment-naïve metastatic castration-sensitive PC (mCSPC) who were treated with apalutamide. The primary outcome was the effect of apalutamide dose reduction on skin-related AEs. The secondary outcomes were the effect of apalutamide dose reduction on skin-related AEs in patients with small body size, postskin AE apalutamide discontinuation rate, and CRPC-free survival in patients with mCSPC treated with upfront apalutamide plus androgen deprivation therapy. RESULTS Of the 107 patients, 65 (60.7%) and 42 (39.3%) were treated with full and reduced doses of apalutamide, respectively. The skin-related AE rate was not significantly different between the groups (55% vs. 43%, p = 0.761). In the group receiving reduced apalutamide dose, the incidence of skin-related AEs was significantly lower in patients with small body sizes (body weight <67 kg and body mass index <24 kg/m2 ) than in those with other body sizes. The postskin AE apalutamide discontinuation rate was significantly differed between patients receiving the full (50%) and reduced (16.7%) doses. In the 72 patients with mCSPC, CRPC-free survival was not significantly different between the full and reduced dose groups. CONCLUSION Apalutamide dose reduction was not significantly associated with the incidence of skin-related AEs. However, dose reduction in patients with small body sizes may alleviate skin-related AEs without sacrificing oncological outcomes.
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Affiliation(s)
- Takuya Oishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryuji Tabata
- Department of Urology, Ageo Central General Hospital, Ageo, Japan
| | - Daiji Fujimori
- Department of Urology, Ageo Central General Hospital, Ageo, Japan
| | - Yohei Kawashima
- Department of Urology, Ageo Central General Hospital, Ageo, Japan
| | - Ryuma Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Noritaka Ishii
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hikari Miura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toshikazu Tanaka
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Sato
- Department of Urology, Ageo Central General Hospital, Ageo, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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19
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Hsu YSO, Hsieh TS, Huang PW, Chu CY. Drug reaction with eosinophilia and systemic symptoms with features resembling Stevens-Johnson syndrome/toxic epidermal necrolysis related to apalutamide. J Eur Acad Dermatol Venereol 2023; 37:e246-e248. [PMID: 36223304 DOI: 10.1111/jdv.18660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/05/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Yun-Shiuan Olivia Hsu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Shiuan Hsieh
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Wei Huang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Flynn CR, Liu SC, Byrne B, Ralph J, Paz G, Anwar S, Buchalter J, Fitzpatrick OM, Markham T, Donnellan P. Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:652-661. [PMID: 37900799 PMCID: PMC10601736 DOI: 10.1159/000532009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 10/31/2023] Open
Abstract
Apalutamide is a novel nonsteroidal androgen receptor inhibitor that has been shown to improve outcomes for patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer when combined with androgen deprivation therapy. Apalutamide-induced skin rash occurred commonly in clinical trials, with 23.8-27.1% of patients experiencing a rash of any grade, and 5.2-6.3% experiencing a rash of grade three or higher. There were no cases of severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) reported in clinical trials; however, there are rare cases reported in the literature with the majority occurring in Asian patients. An 83-year-old Caucasian male was commenced on apalutamide, combined with degarelix, for the management of metastatic castration-sensitive prostate cancer. During week five of apalutamide treatment, the patient developed a widespread erythematous maculopapular rash. On presentation, the rash affected 80% of his body surface area (BSA) and a diagnosis of a severe cutaneous drug eruption was made. He was commenced on methylprednisolone (MP) therapy. Despite 5 days of MP, the rash continued to deteriorate involving 95% of his BSA. Nikolsky's sign was positive. A diagnosis of overlap SJS/TEN was made, supported by skin biopsy. His SCORTEN score was three. He was then commenced on intravenous immunoglobulin and transferred to the intensive care unit. Over the coming days, the rash began to stabilise, and his steroid dose was weaned. He was discharged from hospital 38 days after rash onset. We report the first suggested case of apalutamide-induced SJS/TEN in a Caucasian patient. We discuss other cases of apalutamide-induced SCARs reported in the literature. Risk factors seem to include low body weight and Japanese race, as well as short time to onset of rash.
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Affiliation(s)
- Calvin R. Flynn
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Shun-Chieh Liu
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Berbie Byrne
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - James Ralph
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - Gabriela Paz
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Salman Anwar
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Jemma Buchalter
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | | | - Trevor Markham
- Department of Dermatology, University Hospital Galway, Galway, Ireland
| | - Paul Donnellan
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
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21
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Honda T, Tohi Y, Kaku Y, Kimura N, Kato T, Haba R, Dainichi T, Sugimoto M. Acute generalized exanthematous pustulosis during apalutamide treatment in a patient with prostate cancer. IJU Case Rep 2022; 5:497-500. [PMID: 36341202 PMCID: PMC9626358 DOI: 10.1002/iju5.12525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Acute generalized exanthematous pustulosis is a type of severe cutaneous drug adverse reaction. While apalutamide is known for its high incidence of cutaneous adverse events, it remains unknown whether acute generalized exanthematous pustulosis can develop during apalutamide treatment. Case presentation A 72-year-old man with metastatic castration-sensitive prostate cancer developed small erythema on the face and trunk after 41 days of apalutamide treatment. Three days later, apalutamide was discontinued. However, 9 days after the discontinuation of apalutamide, the patient had a high fever with hemodynamic instability and showed diffuse erythema throughout the body with numerous small pustules. Skin biopsy revealed subcorneal and intraepidermal pustules admixed with many eosinophils, which led to the diagnosis of acute generalized exanthematous pustulosis. The skin rash improved in 14 days with systemic corticosteroid administration. Conclusion We present the first case of a skin rash with clinical features of acute generalized exanthematous pustulosis during apalutamide treatment.
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Affiliation(s)
- Tomoko Honda
- Department of Urology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Yoichiro Tohi
- Department of Urology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Yo Kaku
- Department of Dermatology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Nachino Kimura
- Department of Diagnostic Pathology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Takuma Kato
- Department of Urology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Teruki Dainichi
- Department of Dermatology, Faculty of MedicineKagawa UniversityKagawaJapan
| | - Mikio Sugimoto
- Department of Urology, Faculty of MedicineKagawa UniversityKagawaJapan
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22
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Pons Benavent M, Porcar Saura S, Bou Boluda L. RF-Adverse Skin Reaction to Apalutamide: An Emerging Effect. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:336-338. [PMID: 36206808 DOI: 10.1016/j.ad.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Pons Benavent
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - S Porcar Saura
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - L Bou Boluda
- Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, España
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23
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Osawa K, Kiniwa Y, Shimosato Y, Midorikawa H, Shirai T, Sano T, Nakamura K, Okuyama R. Toxic Epidermal Necrolysis Caused by Apalutamide: A Case Report of Treatment Using Etanercept with Conventional Steroid Therapy. Acta Derm Venereol 2022; 102:adv00723. [DOI: 10.2340/actadv.v102.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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24
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Real-world analysis of apalutamide-associated skin adverse events in Japanese patients with advanced prostate cancer: a multi-institutional study in the Chu-shikoku Japan Urological Consortium. Int J Clin Oncol 2022; 27:1348-1355. [PMID: 35596089 DOI: 10.1007/s10147-022-02183-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Apalutamide-associated skin adverse events are more common in the Japanese than in the global population. However, limited clinical data have hampered further understanding. This real-world study investigated the clinical characteristics of skin adverse events in patients with advanced prostate cancer. METHODS We retrospectively reviewed 119 patient records from 16 institutions in Japan. Skin adverse events were graded according to the Common Terminology Criteria for Adverse Events (v5.0). The incidence and characteristics of skin adverse events (along with the clinical risk factors for their incidence, worsening, and recurrence) were evaluated. RESULTS Fifty-five patients (46.2%) experienced skin adverse events. The median times to the incidence and remission of skin adverse events were 62 and 30 days, respectively. Grade 3 skin adverse events were observed in 15 patients (12.6%). The median time from the first incidence to apalutamide interruption was significantly longer in patients with progression to grade 3 skin adverse events than in those without such a progression (8 vs. 0 days, p = 0.005). Skin adverse events were observed in 45.2% of patients who resumed apalutamide treatment (median treatment interruption time: 31.5 days). Sixteen patients (13.4%) permanently discontinued apalutamide due to skin adverse events. No significant clinical risk factors for the incidence, worsening and recurrence of apalutamide-associated skin adverse events were observed. CONCLUSIONS Nearly half of the Japanese patients in this study experienced skin adverse events following apalutamide administration. The time to apalutamide discontinuation after the incidence of skin adverse events was positively correlated with the worsening of these events.
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25
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Sasaki D, Hatakeyama S, Tanaka T, Okamoto T, Yoneyama T, Ohyama C. Impact of body size on skin‐related adverse events in advanced prostate cancer treated with apalutamide: A multicenter retrospective study. Int J Urol 2022; 29:772-773. [DOI: 10.1111/iju.14860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/13/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Daichi Sasaki
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Toshikazu Tanaka
- Department of Urology Aomori Prefectural Central Hospital Aomori Japan
| | - Teppei Okamoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Chikara Ohyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
- Department of Advanced Blood Purification Therapy Hirosaki University Graduate School of Medicine Hirosaki Japan
- Department of Advanced Transplant and Regenerative Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
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26
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Miyagawa A, Adachi T, Kobayashi Y, Takamiyagi S, Arakawa H, Futatsugi K, Inazumi T. Plasmapheresis as a promising treatment option in apalutamide-associated toxic epidermal necrolysis. J Dermatol 2021; 49:e102-e103. [PMID: 34837271 DOI: 10.1111/1346-8138.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Akihiro Miyagawa
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Takeya Adachi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan.,Department of Medical Regulatory Science, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Keio Frontier Research & Education Collaborative Square at Tonomachi, Keio University, Kanagawa, Japan
| | - Yuki Kobayashi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Saeko Takamiyagi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Hiroki Arakawa
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Koji Futatsugi
- Department of Nephrology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Toyoko Inazumi
- Department of Dermatology, Tachikawa Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
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27
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Tohi Y, Kataoka K, Miyai Y, Kaku Y, Dainichi T, Haba R, Tsunemori H, Sugimoto M. Apalutamide-associated skin rash in patients with prostate cancer: Histological evaluation by skin biopsy. IJU Case Rep 2021; 4:299-302. [PMID: 34497989 PMCID: PMC8413224 DOI: 10.1002/iju5.12331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Apalutamide-associated skin rash is a more common adverse event in the Japanese population than in the global population. However, its mechanism remains elusive, and limited histopathological information hampers further understanding. CASE PRESENTATION Case 1: a 71-year-old man with metastatic castration-sensitive prostate cancer developed a skin rash after 70 days of apalutamide treatment. Case 2: a 71-year-old man with non-metastatic castration-resistant prostate cancer developed a skin rash after 71 days of apalutamide treatment. In both cases, the skin rash presented as a slightly exudative erythema. The histology showed spongiosis of the epidermis and perivascular and interstitial infiltration of lymphocytes and eosinophils in the upper dermis without necrotic keratinocytes. CONCLUSION Apalutamide-induced skin rashes can involve an eczematous reaction clinically and histologically.
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Affiliation(s)
- Yoichiro Tohi
- Department ofUrologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Koki Kataoka
- Department ofDermatologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Yumi Miyai
- Department ofDiagnostic PathologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Yo Kaku
- Department ofDermatologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Teruki Dainichi
- Department ofDermatologyFaculty of MedicineKagawa UniversityKagawaJapan
| | - Reiji Haba
- Department ofDiagnostic PathologyFaculty of MedicineKagawa UniversityKagawaJapan
| | | | - Mikio Sugimoto
- Department ofUrologyFaculty of MedicineKagawa UniversityKagawaJapan
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28
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Uemura H, Koroki Y, Iwaki Y, Imanaka K, Kambara T, Lopez-Gitlitz A, Smith A, Uemura H. Correction to: Skin rash following Administration of Apalutamide in Japanese patients with Advanced Prostate Cancer: an integrated analysis of the phase 3 SPARTAN and TITAN studies and a phase 1 open-label study. BMC Urol 2020; 20:166. [PMID: 33092574 PMCID: PMC7583189 DOI: 10.1186/s12894-020-00739-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yosuke Koroki
- Medical Affairs, Janssen Pharmaceutical K.K., Tokyo, Japan.
| | - Yuki Iwaki
- Clinical Pharmacology, Janssen Pharmaceutical K.K, Tokyo, Japan
| | | | - Takeshi Kambara
- Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Andressa Smith
- Janssen Global Research & Development, Spring House, PA, USA
| | - Hirotsugu Uemura
- Department of Urology, Faculty of Medicine, Kindai University, Osaka, Japan
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