News in brief: Apalutamide on PBS for prostate cancer; Combination oxycodone-naloxone pain relief shortage continues; Bleeding risk particularly high in brain cancer patients 


Apalutamide on PBS for prostate cancer

Apalutamide (Eryland) is now PBS-listed for men with non-metastatic castration-resistant prostate cancer (nmCRPC) who are at increased risk of metastasis and death.

From 1 May, the androgen receptor antagonist will be subsidised for nmCRPC patients whose prostate specific antigen (PSA) levels double in less than or equal to 10 months despite treatment with testosterone-lowering medication and who don’t have evidence of distant metastasis using conventional imaging techniques.

The oral therapy helps inhibit the action of testosterone in prostate cancer cells and works by preventing androgen from binding to the androgen receptor.

Manufactured by Janssen, the once-daily 60 mg tablet can be taken with or without food and is used in combination with androgen deprivation therapy.


Combination oxycodone-naloxone pain relief shortage continues

Cancer patients may struggle to access adequate pain relief as the combination oxycodone-naloxone (Targin) therapy shortage continues.

From 1 March, the 10/5 mg and 20/10 mg modified release tablets were of poor availability, leading clinicians to prescribe the drug at alternative strengths. The action cascaded and “now all the strengths are unavailable and there is no equivalent”, Dr Abhishek Joshi, medical oncologist at Townsville Icon Cancer Care and Townsville University Hospital told ABC News.

It was hoped supplies would be replenished in April, however the TGA now expects that won’t happen until the end of May, the ABC reported.

Blamed on transport and shipping issues, drug provider Mundipharma said it was doing “all [it] can to address these challenges in order to establish a long-term, sustainable, and reliable supply of this important medicine”.

It’s negotiating with shipping and air carriers “to ensure freight prioritisation for these critical medicines”, the ABC article stated.


Bleeding risk particularly high in brain cancer patients 

Glioblastoma patients are at high risk of venous thromboembolism and major bleeding which in turn is linked to a poor prognosis, researchers report.

Of a cohort of almost 1,000 glioblastoma patients diagnosed between 2004-2020, 101 were diagnosed with venous thromboembolism (VTE), 50 with arterial thromboembolism (ATE)  and 126 with major bleeding during a median follow-up of 15 months. 

The adjusted one year cumulative incidence of venous thromboembolism was 7.5%, arterial thromboembolism 4.1% and major bleeding was 12%, the research team from The Netherlands reported. 

Both VTE and major bleeding was associated with mortality, conferring an adjusted Hazards Ratio of 1.3 and 1.7 respectively. 

Writing in the Journal of Thrombosis and Haemostasis the researchers acknowledged that their findings may not reflect contemporary anticoagulation treatment as the majority of patients in the cohort had received LMWH. 

Nevertheless, for now the  particularly  high  bleeding  incidence could  be  used  as  an  argument  to  “consider  a  limited  duration  of anticoagulant  treatment  (3-6  months,  as  VTE  recurrence  risk  is  highest  during  this  period in glioblastoma patients diagnosed with incident VTE, and to follow ISTH guidance suggesting against routine pharmacological thromboprophylaxis in ambulatory patients,” they argued. 

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