Adding Darolutamide To The Treatment Plan
- Darolutamide is an androgen-receptor pathway inhibitor (ARPI). It is emerging as a top choice for men whose cancer is not responding well to hormone therapy (ADT) alone.
- Since prostate cancer needs androgens (hormones) to grow, cutting off that fuel is central to therapy. However, for some patients, cancer still finds a way to grow even while on ADT — this is where ARPIs can come in.
- Darolutamide adds power to standard hormone therapy and is generally well‑tolerated. Experts believe it has a better side effect profile than other, older ARPIs that are currently available.
- Common side effects reported by patients using darolutamide include tiredness, mild nausea, and joint pain.
Androgen deprivation therapy (ADT) plays a key role in prostate cancer treatment. But for some patients, a second drug called androgen-receptor pathway inhibitors (ARPIs) is needed to work alongside ADT. They help block cancer growth and delay progression.
Read More“It can be used up-front with androgen deprivation therapy or it can be used in very aggressive patients in what we call triplet therapy, where you add chemotherapy up-front,” Dr. Kelly explains.
First-Line Androgen‑Deprivation Therapy (ADT)
ADT, also called “chemical castration,” involves prescribing patients hormones that will “tell” the testicles to stop producing testosterone, pushing the blood levels down similar to those who have undergone an operation. This therapy can keep the cancer quiet for years and promote better outcomes.
Although this exponential decrease in testosterone levels is meaningful, some hormone receptors inside the cancer cells are able to respond to the remnant hormones and replicate.
Thus, some patients may need to take a second drug to inhibit these receptors, which are called androgen‑receptor pathway inhibitors (ARPIs). These include enzalutamide, apalutamide, and darolutamide; all work alongside ADT to deepen hormone blockade and delay progression.
Darolutamide: A Next‑Generation ARPI
Darolutamide was engineered so that very little of it goes into the brain. Early studies show it causes less fatigue, fewer muscle issues, and fewer heart‑related side effects than some older ARPIs. No drug is side‑effect‑free, but this unique profile makes darolutamide a powerful option for many men.
Dr. Kelly adds that while darolutamide is an ARPI and thus, similar to enzalutamide and apalutamide, “It was built on a little different platform, so it has a different profile.”
It can be used in several situations, including for non‑metastatic castration‑resistant prostate cancer, or in other words, for patients with local disease who haven’t had a good response to ADT alone.
Recent research showed that adding the drug to ADT held cancer in check for a median of 40 months, versus 18 months with a placebo for these patients.
Another scenario of darolutamide indication is in patients with metastatic hormone‑sensitive prostate cancer. A different study showed that combining darolutamide with ADT and the chemotherapy drug docetaxel (so‑called triplet therapy) cut the risk of death by about one‑third compared with ADT + docetaxel alone.
These studies translate the number into real-world benefits: longer life, longer time before the cancer spreads, and — importantly — maintained quality of life for many participants.
Side Effects
While one of the benefits of darolutamide is that it may produce fewer side effects than other ARPIs, all drugs have the potential to cause side effects.
Darolutamide was designed to avoid crossing a natural membrane/barrier that protects our nervous system from the blood. With that, this agent has been linked to rarer cases of neurologic symptoms compared to the older options.
In addition, cardiac-related problems were also rare in the population receiving darolutamide. Common side effects reported by patients include tiredness, mild nausea, and joint pain.
Questions To Ask Your Doctor
- Am I a candidate for darolutamide?
- What are the realistic benefits for my stage of disease?
- How can I monitor for side effects?
- Could triplet therapy offer me extra benefit, and am I fit enough for chemotherapy?
- How will this treatment interact with my other health conditions?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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