Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer
Open accessAbstract
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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Multiple phase 3 clinical trials have demonstrated the benefit of AR-targeted therapies on patient survival.
“Multiple phase 3 clinical trials have demonstrated the benefit of AR-targeted therapies on patient survival9–18.”
From Genome-scale CRISPR screens identify PTGES3 as a direct modulator of androgen receptor function in advanced prostate cancer (2025) · cites this paper as [14]
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- Authors
- Chi, K. N., Agarwal, N., Bjartell, A., Chung, B. H., Pereira de Santana Gomes, A. J., Given, R., Juárez Soto, Á., Merseburger, A. S., Özgüroğlu, M., Uemura, H., Ye, D., Deprince, K., Naini, V., Li, J., Cheng, S., Yu, M. K., Zhang, K., Larsen, J. S., McCarthy, S., & Chowdhury, S.
- Affiliations
- Eastern Virginia Medical School (US)
- From BC Cancer and Vancouver Prostate Centre, Vancouver, Canada (K.N.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (N.A.); Skåne University Hospital, Lund University, Malmö, Sweden (A.B.); Yonsei University College of Medicine and Gangnam Severance Hospital, Seoul, South Korea (B.H.C.); Liga Norte Riograndense Contra o Câncer, Natal, Brazil (A.J.P.S.G.); Urology of Virginia, Eastern Virginia Medical School, Norfolk (R.G.); Hospital Universitario de Jerez de la Frontera, Cadiz,...
- Janssen (Belgium) (BE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2019-07-04
- Volume
- 381
- Issue
- 1
- Pages
- 13-24
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2947014957
- Cited by
- 1,564
- References
- 25
- Citations by year
- 2026: 188 · 2025: 219 · 2024: 236 · 2023: 205 · 2022: 238 · 2021: 235 · 2020: 184 · 2019: 49 · 2017: 1 · 2014: 1
- FWCI
- 129.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Lund University Publications (Lund University) (submittedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Janssen Research and Development
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
- Keywords
- apalutamide, metastatic hormone-sensitive prostate cancer, androgen receptor antagonists, androgen deprivation therapy, radiographic progression-free survival, overall survival, docetaxel, adverse events, rash, prostate cancer treatment, metastatic castration-resistant prostate cancer
- MeSH terms
- Progression-Free Survival, Adenocarcinoma, Adult, Aged, Aged, 80 and over, Androgen Antagonists, Antineoplastic Combined Chemotherapy Protocols, Double-Blind Method, Exanthema, Humans, Male, Middle Aged, Prostatic Neoplasms, Quality of Life, Radiography, Thiohydantoins, Kaplan-Meier Estimate, Androgen Receptor Antagonists, Neoplasm Grading
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