Apalutamide Induced Neutropenia: An Unusual Side Effect and a Literature Review

Author(s): Feras A Moria, Changsu L Park, Ramy R Saleh

Prostate cancer is among the most frequently diagnosed cancers and a leading cause of cancer-related mortality in men worldwide. Newer generation Androgen receptor axis targeted (ARAT) has been implemented in the management of prostate cancer in both metastatic hormonal sensitive and resistant settings. It has been associated with great efficacy, well tolerability and an acceptable safety profile. We report a case of an 80-year-old male with metastatic Hormonal Sensitive Prostate Cancer (mHSPC) who developed febrile neutropenia secondary to newer generation ARAT (Apalutumide) which has completely resolved following drug interruption and short course GCSF support. To the best of our knowledge, this is the first report of apalutumide associated febrile neutropenia, literature reviewing revealed that the incidence of febrile neutropenia in patients receiving ARAT is not common and most of the febrile neutropenia in patients with prostate cancer occurs in patients receiving chemotherapy. Although this is an extremely rare adverse event caution should exercise when prescribing these drugs especially with the emerging evidence supporting the combination of ARAT’s and Poly (ADP-ribose) polymerase (PARP) inhibitors