Apalutamide compared to the other Lutamides

[Moespy]

Apalutamide sounds like a great choice for those that are Metastatic and still Hormone Sensitive. practiceupdate.com/C/117492/56

Let us know what you think about Apalutamide compared to the other Lutamides.

[6357axbz]

I think you need to compare ADT + Apalutimide to ADT + Abiraterone Acetate (Zytiga) to determine which is better for mHSPCa

[Moespy in reply to 6357axbz]

Any thoughts on which might be more effective?

[6357axbz in reply to Moespy]

I can’t say for sure but I think abi may be more effective. I’m sure others here who know will chime in.

[CAMPSOUPS in reply to 6357axbz]

You hit the nail on the head. Comparison between Zytiga and Apalutamide is on my wish list.

The study seems to NOT indicate strong side effects but maybe the same was true of the Zytiga trial(s). Then when those of us here report we start to see the side effects of such treatments.

Also my simpleton brain cant recall the method of action for Zytiga other than: inhibits androgen at 3 sources—the

testes, the adrenal glands, AND the tumor itself.

For Apalutamide: Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor.

nejm.org/doi/full/10.1056/N...

[Tall_Allen]

I think you mean antiandrogens. The early antiandrogens (nilutamide, bicalutamide, etc.) were much weaker and the androgen receptor learned to feed on them quickly (called Antiandrogen withdrawal syndrome). They aren't used at all anymore, except for a few weeks at the start of GnRH agonist therapy to prevent pain flare in metastatic men, and in some recurrent, non-metastatic men.

The new generation of antiandrogens (Xtandi, Erleada & Nubeqa) are MUCH more powerful at blocking the androgen receptor. In addition, they may prevent its upgrading and translocation into the nucleus. They delay castration resistance and extend life markedly. While Xtandi withrawal syndrome has been observed, it is rare. The price for the increased efficacy is increased side effects.

I would put Zytiga into this category, although it isn't an antiandrogen.

Why do you ask?

[Moespy in reply to Tall_Allen]

I was wondering if I do move further down the road to metastatic hormone-sensitive which would be the best choice first line of defence. Taxotere would likely be involved in this scenario also. As always just keeping my ear to the ground in hopes of understanding what the docs will recommend if that day comes.

[Tall_Allen in reply to Moespy]

By the time "that day comes" there will be other options. New meds have been coming out quickly. There is no benefit in "keeping your ear to the ground" when the ground is always shifting.

[Hidden in reply to Tall_Allen]

Agreed! Live in the present

[Moespy in reply to Tall_Allen]

Great advice! The only problem is I will have to find something else to fret about!

[GoBucks in reply to Moespy]

Worry about the Tigers' hitting. When will they show up?

[Moespy in reply to GoBucks]

Go Tigers!

[Hidden in reply to GoBucks]

😂😂

[Hidden in reply to Moespy]

The world is full of reasons.😷✌️

[tango65]

pubmed.ncbi.nlm.nih.gov/334...

Castration sensitive

[Moespy in reply to tango65]

Two things: Thanks for the article! My MO is a contributor to the article. Nice confidence builder.

[tango65 in reply to Moespy]

You are welcome. Best of luck !!!

[LearnAll]

So nobody want to talk about increased likelyhood of serious side effects and worse treatment emergent NeuroEndocrine differentiation with extremely strong ADTs.? Fine .My Bica is still doing its job with almost no side effect.

[Spyder54 in reply to LearnAll]

LearnAll. Bica is Bicalutamide/Casodex? I thought Casodex is never a Monotherapy? I see on your bio you also take Dutesteride? Your results without surgery or ebrt are impressive. I’m also plant based for 8mos now. Can I add Bica to my Firmagon, Zytiga, Prednisone regimen?

[LearnAll in reply to Spyder54]

Bicalutamide is an anti androgen just like Enzalutamide. Meaning both of these meds block the EFFECT of Androgens on the prostate. They are in the same class.OTOH, Abiraterone (Zytiga) is a very strong testosterone suppressor...meaning it takes T to even lower level than lupron alone.

As of now, there is no clear consensus if the meds from these two different classes can be combined or not.

If Enza lutamide did not work on some one ..it is likely that Bica lutamide will not work.

Plant based, sulforaphane rich, resveratrol rich, Lycopene rich will help ...no matter what color your PCa is. Same with physical exercise.

[Spyder54 in reply to LearnAll]

LearnAll. You have Learned well! Gratzee’

[Spyder54]

There are Phase III trials of Apalutimide/Erleada with Abiriterone/Zytiga with Prednisone. This combo appears to extend OS, and delay biochemical recurrence.

[Boywonder56]

Ive been in titan trial going on 4.5 yrs...erleada /lupron.....se suck....but has put aggressive g9 wmets to sleep ...psa has been <.01.....just now .1.....i feel its worth the se .bw

[Boywonder56]

I wonder if I had prednisone I probably blow up like a freaking whale

[Hidden in reply to Boywonder56]

Please, just not a sperm whale.

[MateoBeach]

For mHSPC it appears adding a irate roñé to ADT May be preferred for high volume or visceral Mets. For low volume disease enzalutamide may be preferable. pubmed.ncbi.nlm.nih.gov/330...

Comparison of Current Systemic Combination Therapies for Metastatic Hormone-Sensitive Prostate Cancer and Selection of Candidates for Optimal Treatment: A Systematic Review and Bayesian Network Meta-Analysis

Objective: To compare the efficacy and safety of current systemic combination therapies for patients with mHSPC and help select candidates for optimal treatment. Methods: Databases of MEDLINE and EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trial.gov were searched for eligible studies. Direct and network meta-analysis were conducted to compare various systemic combination therapies and the surface under the cumulative ranking curve (SUCRA) was generated for treatment ranking. Subgroup analyses were performed according to the extent of metastasis. Adverse events (AEs) were compared among the effective treatments. Results: Ten trials with 16 publications were included in this network meta-analysis. Direct and network meta-analysis consistently suggested that androgen-deprivation therapy (ADT) combined with docetaxel, abiraterone, enzalutamide, or apalutamide could significantly improve overall survival (OS) and failure-free survival (FFS) compared to ADT alone in men with mHSPC. SUCRA analysis demonstrated the superiority of ADT plus abiraterone or enzalutamide over other therapies. Subgroup analyses indicated that additional abiraterone to ADT had the highest ranking in patients with high-volume diseases or visceral metastases and enzalutamide plus ADT outperformed other treatments in patients with low-volume diseases or without visceral metastases. Different combination therapies had variable AE profiles and ADT in addition with docetaxel or abiraterone had the highest risk of AEs. Conclusion: ADT plus docetaxel, abiraterone, enzalutamide, or apalutamide were associated with significantly improved survival in patients with mHSPC. ADT plus abiraterone or enzalutamide appeared to be the most effective treatments. Clinicians should balance the efficacy, potential AEs, and disease status to select the optimal treatment.