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Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer

Chi, Kim N ; Agarwal, Neeraj ; Bjartell, Anders LU ; Chung, Byung Ha ; Pereira de Santana Gomes, Andrea J ; Given, Robert ; Juárez Soto, Álvaro ; Merseburger, Axel S ; Özgüroğlu, Mustafa and Uemura, Hirotsugu , et al. (2019) In New England Journal of Medicine 381(1). p.13-24
Abstract

BACKGROUND: Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor. Whether the addition of apalutamide to androgen-deprivation therapy (ADT) would prolong radiographic progression-free survival and overall survival as compared with placebo plus ADT among patients with metastatic, castration-sensitive prostate cancer has not been determined.

METHODS: In this double-blind, phase 3 trial, we randomly assigned patients with metastatic, castration-sensitive prostate cancer to receive apalutamide (240 mg per day) or placebo, added to ADT. Previous treatment for localized disease and previous docetaxel therapy were allowed. The primary end points were radiographic progression-free survival and overall... (More)

BACKGROUND: Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor. Whether the addition of apalutamide to androgen-deprivation therapy (ADT) would prolong radiographic progression-free survival and overall survival as compared with placebo plus ADT among patients with metastatic, castration-sensitive prostate cancer has not been determined.

METHODS: In this double-blind, phase 3 trial, we randomly assigned patients with metastatic, castration-sensitive prostate cancer to receive apalutamide (240 mg per day) or placebo, added to ADT. Previous treatment for localized disease and previous docetaxel therapy were allowed. The primary end points were radiographic progression-free survival and overall survival.

RESULTS: A total of 525 patients were assigned to receive apalutamide plus ADT and 527 to receive placebo plus ADT. The median age was 68 years. A total of 16.4% of the patients had undergone prostatectomy or received radiotherapy for localized disease, and 10.7% had received previous docetaxel therapy; 62.7% had high-volume disease, and 37.3% had low-volume disease. At the first interim analysis, with a median of 22.7 months of follow-up, the percentage of patients with radiographic progression-free survival at 24 months was 68.2% in the apalutamide group and 47.5% in the placebo group (hazard ratio for radiographic progression or death, 0.48; 95% confidence interval [CI], 0.39 to 0.60; P<0.001). Overall survival at 24 months was also greater with apalutamide than with placebo (82.4% in the apalutamide group vs. 73.5% in the placebo group; hazard ratio for death, 0.67; 95% CI, 0.51 to 0.89; P = 0.005). The frequency of grade 3 or 4 adverse events was 42.2% in the apalutamide group and 40.8% in the placebo group; rash was more common in the apalutamide group.

CONCLUSIONS: In this trial involving patients with metastatic, castration-sensitive prostate cancer, overall survival and radiographic progression-free survival were significantly longer with the addition of apalutamide to ADT than with placebo plus ADT, and the side-effect profile did not differ substantially between the two groups. (Funded by Janssen Research and Development; TITAN ClinicalTrials.gov number, NCT02489318.).

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published
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New England Journal of Medicine
volume
381
issue
1
pages
12 pages
publisher
Massachusetts Medical Society
external identifiers
  • pmid:31150574
  • scopus:85068436470
ISSN
0028-4793
DOI
10.1056/NEJMoa1903307
language
English
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yes
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Copyright © 2019 Massachusetts Medical Society.
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5a8c4cad-e246-4d33-bed6-0c8d3f6a8444
date added to LUP
2019-06-26 09:55:19
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2020-01-16 04:00:23
@article{5a8c4cad-e246-4d33-bed6-0c8d3f6a8444,
  abstract     = {<p>BACKGROUND: Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor. Whether the addition of apalutamide to androgen-deprivation therapy (ADT) would prolong radiographic progression-free survival and overall survival as compared with placebo plus ADT among patients with metastatic, castration-sensitive prostate cancer has not been determined.</p><p>METHODS: In this double-blind, phase 3 trial, we randomly assigned patients with metastatic, castration-sensitive prostate cancer to receive apalutamide (240 mg per day) or placebo, added to ADT. Previous treatment for localized disease and previous docetaxel therapy were allowed. The primary end points were radiographic progression-free survival and overall survival.</p><p>RESULTS: A total of 525 patients were assigned to receive apalutamide plus ADT and 527 to receive placebo plus ADT. The median age was 68 years. A total of 16.4% of the patients had undergone prostatectomy or received radiotherapy for localized disease, and 10.7% had received previous docetaxel therapy; 62.7% had high-volume disease, and 37.3% had low-volume disease. At the first interim analysis, with a median of 22.7 months of follow-up, the percentage of patients with radiographic progression-free survival at 24 months was 68.2% in the apalutamide group and 47.5% in the placebo group (hazard ratio for radiographic progression or death, 0.48; 95% confidence interval [CI], 0.39 to 0.60; P&lt;0.001). Overall survival at 24 months was also greater with apalutamide than with placebo (82.4% in the apalutamide group vs. 73.5% in the placebo group; hazard ratio for death, 0.67; 95% CI, 0.51 to 0.89; P = 0.005). The frequency of grade 3 or 4 adverse events was 42.2% in the apalutamide group and 40.8% in the placebo group; rash was more common in the apalutamide group.</p><p>CONCLUSIONS: In this trial involving patients with metastatic, castration-sensitive prostate cancer, overall survival and radiographic progression-free survival were significantly longer with the addition of apalutamide to ADT than with placebo plus ADT, and the side-effect profile did not differ substantially between the two groups. (Funded by Janssen Research and Development; TITAN ClinicalTrials.gov number, NCT02489318.).</p>},
  author       = {Chi, Kim N and Agarwal, Neeraj and Bjartell, Anders and Chung, Byung Ha and Pereira de Santana Gomes, Andrea J and Given, Robert and Juárez Soto, Álvaro and Merseburger, Axel S and Özgüroğlu, Mustafa and Uemura, Hirotsugu and Ye, Dingwei and Deprince, Kris and Naini, Vahid and Li, Jinhui and Cheng, Shinta and Yu, Margaret K and Zhang, Ke and Larsen, Julie S and McCarthy, Sharon and Chowdhury, Simon},
  issn         = {0028-4793},
  language     = {eng},
  month        = {07},
  number       = {1},
  pages        = {13--24},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer},
  url          = {http://dx.doi.org/10.1056/NEJMoa1903307},
  doi          = {10.1056/NEJMoa1903307},
  volume       = {381},
  year         = {2019},
}