Apalutamide (Erleada)

General information

Class/mechanism: Antiandrogen; androgen receptor inhibitor (ARI). Apalutamide competitively inhibits activity mediated by the androgen receptor (AR) by binding directly to the AR ligand-binding domain, nuclear translocation, DNA binding, and AR-mediated transcription. A metabolite of apalutamide, N-desmethyl apalutamide, also exhibits some AR inhibiting activity, about 1/3 that of apalutamide.^[1]^[2]^[3]
Route: PO
Extravasation: n/a

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.^[1]

Diseases for which it is used

Prostate cancer

Patient drug information

History of changes in FDA indication

2018-02-14: FDA approved for patients with non-metastatic castration-resistant prostate cancer (NM-CRPC). (Based on SPARTAN)
2019-09-17: Approved for patients with metastatic castration-sensitive prostate cancer (mCSPC). (Based on TITAN_prostate)

History of changes in EMA indication

2019-01-14: Initial marketing authorization as Erleada. Erleada is indicated in adult men for the treatment of non-metastatic castration resistant prostate cancer (NM CRPC) who are at high risk of developing metastatic disease. (Based on SPARTAN)
2020-01-27: Extension of Indication to include the treatment of metastatic hormone-sensitive prostate cancer (mHSPC) in combination with androgen deprivation therapy (ADT). (Based on TITAN_prostate)

History of changes in Health Canada indication

2018-07-03: Initial notice of compliance for the treatment of patients with non-metastatic castration-resistant prostate cancer at high risk of developing metastases.
2019-12-12: New indication

History of changes in PMDA indication

2019-03-26: New approval for the treatment of non-metastatic, castration-resistant prostate cancer.
2020-05-29: New indication for the treatment of metastatic prostate cancer.

Also known as

Code name: ARN-509
Brand name: Erleada

References

[insert-1] 1.0 ^1.1 ^1.2 Apalutamide (Erleada) package insert

[2] Apalutamide (Erleada) package insert (locally hosted backup)

[3] Erleada manufacturer's website

[4] Apalutamide (Erleada) patient drug information (Chemocare)

[5] Apalutamide (Erleada) patient drug information (UpToDate)

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