Early Identification and Management of Patients with Rash on Apalutamide
Authored by Alison Birtle, published on 2026-04-20 20:02:35.0
Patient on apalutamide presents with rash
Determine cause of rash
If other cause identified, treat according to aetiology (if cause unclear, refer to dermatology)* If other causes excluded, manage as ADR and grade rash using NCI-CTCAE.
Grade 1
Continue apalutamide at the same dose
Monitor for change in severity every 5–7 days
If rash is stable or improving, continue current treatment until rash resolves
If rash worsens or does not improve, follow guidance for Grade 3 and refer to a dermatologist*
Pause apalutamide until rash is Grade ≤1
Monitor for change in severity every 5–7 days
If rash improves to Grade 2, continue current management
Monitor at least once per week
If rash improves to Grade ≤1
If rash is the same or has worsened, refer to a dermatologist*
If rash is the same or has worsened, refer to a dermatologist*
If rash improves to Grade ≤1
Grade 2
Continue apalutamide at the same dose
Monitor for change in severity every 5–7 days
If rash is stable or improving, continue current treatment until rash resolves
If rash worsens or does not improve, follow guidance for Grade 3 and refer to a dermatologist*
Pause apalutamide until rash is Grade ≤1
Monitor for change in severity every 5–7 days
If rash improves to Grade 2, continue current management
Monitor at least once per week
If rash improves to Grade ≤1
If rash is the same or has worsened, refer to a dermatologist*
If rash is the same or has worsened, refer to a dermatologist*
If rash improves to Grade ≤1
Grade 3 (If signs of DRESS/SJS/TEN, refer to dermatology)*
Pause apalutamide until rash is Grade ≤1
Monitor for change in severity every 5–7 days
If rash improves to Grade 2, continue current management
Monitor at least once per week
If rash improves to Grade ≤1
If rash is the same or has worsened, refer to a dermatologist*
If rash is the same or has worsened, refer to a dermatologist*