Apalutamide: A Cause of Neutropenic Sepsis

Prostate cancer is one of the most frequently diagnosed cancers and poses a significant health burden. New androgen-targeted therapies are now standard treatments for various stages of prostate cancer, including hormone-sensitive, metastatic, and non-metastatic castration-resistant types. These therapies are generally well tolerated and often have fewer side effects compared to traditional chemotherapy. Neutropenia and myelosuppression are considered very rare events with such medication and are more commonly associated with cytotoxic chemotherapy, such as docetaxel. Neutropenic sepsis is a serious condition that requires prompt recognition and aggressive management. Healthcare providers should be vigilant in monitoring blood counts and educating patients on the signs of infection to mitigate the risks associated with this potentially life-threatening complication which include acute kidney injury (AKI), hepatic encephalopathy, heart failure, central nervous system dysfunction, acute respiratory distress syndrome (ARDS) or acute respiratory failure, coagulopathy, and death. Here, we describe the case of a 65-year-old man with metastatic hormone-sensitive prostate cancer who experienced neutropenic sepsis and myelosuppression as a result of treatment with the newer agent apalutamide. To our knowledge, this is only the second documented case of such side effects and the first to involve myelosuppression.