ARPI Intensification Raises Any-Grade Neutropenia Modestly, Not Severe Neutropenia

This meta-analysis of eight phase 3 trials isolates the hematologic signal of androgen receptor pathway inhibitor (ARPI) intensification, a toxicity rarely examined in prostate cancer, and clarifies when blood count monitoring matters for oncology pharmacists.

📅 Journal publication: Aug 22, 2026 · Last updated: Oct 13, 2026

androgen receptor pathway inhibitorsenzalutamideabirateronedarolutamidedocetaxelprostate cancerneutropeniahematologic toxicitymeta-analysissupportive careoncology pharmacy Oncology Pharmacy

Background Information

ARPI intensification in prostate cancer modestly boosts neutropenia risk.

Neutropenia is a significant adverse effect in prostate cancer therapies; understanding its risk with androgen receptor pathway inhibitors (ARPIs) informs clinical decisions. ARPI intensification led to a modest increase in any grade neutropenia (3.5% vs 2.9%; RR 1.35) but no significant increase in grade 3 or higher neutropenia (7.5% vs 7.8%; RR 1.09). The study provides moderate evidence of increased risk for any grade neutropenia with ARPIs, suggesting careful monitoring, especially with chemotherapy. ARPI intensification modestly increases any grade neutropenia risk, but not severe cases; monitor blood counts with myelosuppressive therapy.

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Authors: Zhang J, Zhang A, Tian J, Wang S, Xiao M

Citation: Zhang J, Zhang A, Tian J, et al. Neutropenia events with androgen receptor pathway inhibitor-containing versus control therapies in prostate cancer patients: a systematic review and meta-analysis. BMC cancer. 2026;26(1). doi:10.1186/s12885-026-16782-w

Article Links: PubMed · Journal / DOI

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