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

• Published in: BMC urology 2020-09, Vol.20 (1), p.139-139, Article 139
• Main Authors: Uemura, Hiroji, Koroki, Yosuke, Iwaki, Yuki, Imanaka, Keiichiro, Kambara, Takeshi, Lopez-Gitlitz, Angela, Smith, Andressa, Uemura, Hirotsugu
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Androgens; Antihistamines; Apalutamide; Cancer metastasis; Cancer patients; Cancer research; Cancer therapies; Castration; Chemotherapy; Consent; Corticosteroids; Cytotoxicity; Double-Blind Method; Drug Eruptions - etiology; Erythema; Exanthema; Exanthema - chemically induced; Humans; Japan; Japanese; Male; Metastases; Metastasis; Middle Aged; Neoplasm Staging; Patients; Pharmacokinetics; Plasma; Plasma physics; Prostate cancer; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Prostatic Neoplasms, Castration-Resistant - drug therapy; Prostatic Neoplasms, Castration-Resistant - pathology; Rash; Remission; Retrospective Studies; Risk factors; Skin; Skin rash; Thiohydantoins - adverse effects; Urology
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-020-00689-0

A higher incidence of apalutamide-related skin rash has been observed in Japanese patients with prostate cancer (PC). This integrated analysis of data of Japanese patients from 2 global Phase 3 studies, SPARTAN ( NCT01946204 ; patients with non-metastatic castration-resistant PC [nmCRPC]) and TITAN ( NCT02489318 ; patients with metastatic castration-sensitive PC [mCSPC]), and the Phase 1 study 56021927PCR1008 ( NCT02162836 ; patients with metastatic CRPC [mCRPC]), assessed clinical risk factors of apalutamide-related skin rash as well as the potential correlation with plasma exposure to apalutamide. Kaplan-Meier method was used for time-to-event analyses. Clinical risk factors for skin rash were assessed using odds ratio. Data from 68 patients (SPARTAN: n = 34, TITAN: n = 28, 56021927PCR1008: n = 6) receiving apalutamide 240 mg orally once-daily were analyzed. Rash (13 [19.1%]) and maculo-papular rash (11 [16.2%]) were the most frequently reported skin rash. All Grade and Grade 3 skin rash occurred in 35 (51.5%) and 10 (14.7%) patients, respectively. Most (85.7%) skin rash occurred within 4 months of apalutamide initiation and resolved in a median time of 1 month following the use of antihistamines, topical or systemic corticosteroids, with/without apalutamide dose interruptions/reductions. Median time-to-remission of first incidence of rash and maximum grade incidence of rash were 1.0 month (IQR: 0.36-1.81) and 1.0 month (IQR: 0.30-2.43), respectively. No significant clinical risk factors for the incidence of skin rash were observed. Areas under the curve (0-24 h) (AUC ) at steady-state of plasma apalutamide concentration were numerically slightly higher in patients with skin rash than those without. No clinical risk factors for rash could be detected. There is a potential correlation between incidence of skin rash and plasma exposure to apalutamide. In general, apalutamide-related skin rash is easily managed, with appropriate treatment with or without dose adjustment. Retrospective pooled analysis of NCT01946204 , NCT02489318 , and NCT02162836 .