TY - JOUR
T1 - Apalutamide treatment and metastasis-free survival in prostate cancer
AU - Smith, Matthew R.
AU - Saad, Fred
AU - Chowdhury, Simon
AU - Oudard, Stéphane
AU - Hadaschik, Boris A.
AU - Graff, Julie N.
AU - Olmos, David
AU - Mainwaring, Paul N.
AU - Lee, Ji Youl
AU - Uemura, Hiroji
AU - Lopez-Gitlitz, Angela
AU - Trudel, Géralyn C.
AU - Espina, Byron M.
AU - Shu, Youyi
AU - Park, Youn C.
AU - Rackoff, Wayne R.
AU - Yu, Margaret K.
AU - Small, Eric J.
AU - SPARTAN Investigators
A2 - Poulsen, Mads Hvid
PY - 2018/4/12
Y1 - 2018/4/12
N2 - BACKGROUND: Apalutamide, a competitive inhibitor of the androgen receptor, is under development for the treatment of prostate cancer. We evaluated the efficacy of apalutamide in men with nonmetastatic castration-resistant prostate cancer who were at high risk for the development of metastasis.METHODS: We conducted a double-blind, placebo-controlled, phase 3 trial involving men with nonmetastatic castration-resistant prostate cancer and a prostate-specific antigen doubling time of 10 months or less. Patients were randomly assigned, in a 2:1 ratio, to receive apalutamide (240 mg per day) or placebo. All the patients continued to receive androgen-deprivation therapy. The primary end point was metastasis-free survival, which was defined as the time from randomization to the first detection of distant metastasis on imaging or death.RESULTS: A total of 1207 men underwent randomization (806 to the apalutamide group and 401 to the placebo group). In the planned primary analysis, which was performed after 378 events had occurred, median metastasis-free survival was 40.5 months in the apalutamide group as compared with 16.2 months in the placebo group (hazard ratio for metastasis or death, 0.28; 95% confidence interval [CI], 0.23 to 0.35; P<0.001). Time to symptomatic progression was significantly longer with apalutamide than with placebo (hazard ratio, 0.45; 95% CI, 0.32 to 0.63; P<0.001). The rate of adverse events leading to discontinuation of the trial regimen was 10.6% in the apalutamide group and 7.0% in the placebo group. The following adverse events occurred at a higher rate with apalutamide than with placebo: rash (23.8% vs. 5.5%), hypothyroidism (8.1% vs. 2.0%), and fracture (11.7% vs. 6.5%).CONCLUSIONS: Among men with nonmetastatic castration-resistant prostate cancer, metastasis-free survival and time to symptomatic progression were significantly longer with apalutamide than with placebo. (Funded by Janssen Research and Development; SPARTAN ClinicalTrials.gov number, NCT01946204 .).
AB - BACKGROUND: Apalutamide, a competitive inhibitor of the androgen receptor, is under development for the treatment of prostate cancer. We evaluated the efficacy of apalutamide in men with nonmetastatic castration-resistant prostate cancer who were at high risk for the development of metastasis.METHODS: We conducted a double-blind, placebo-controlled, phase 3 trial involving men with nonmetastatic castration-resistant prostate cancer and a prostate-specific antigen doubling time of 10 months or less. Patients were randomly assigned, in a 2:1 ratio, to receive apalutamide (240 mg per day) or placebo. All the patients continued to receive androgen-deprivation therapy. The primary end point was metastasis-free survival, which was defined as the time from randomization to the first detection of distant metastasis on imaging or death.RESULTS: A total of 1207 men underwent randomization (806 to the apalutamide group and 401 to the placebo group). In the planned primary analysis, which was performed after 378 events had occurred, median metastasis-free survival was 40.5 months in the apalutamide group as compared with 16.2 months in the placebo group (hazard ratio for metastasis or death, 0.28; 95% confidence interval [CI], 0.23 to 0.35; P<0.001). Time to symptomatic progression was significantly longer with apalutamide than with placebo (hazard ratio, 0.45; 95% CI, 0.32 to 0.63; P<0.001). The rate of adverse events leading to discontinuation of the trial regimen was 10.6% in the apalutamide group and 7.0% in the placebo group. The following adverse events occurred at a higher rate with apalutamide than with placebo: rash (23.8% vs. 5.5%), hypothyroidism (8.1% vs. 2.0%), and fracture (11.7% vs. 6.5%).CONCLUSIONS: Among men with nonmetastatic castration-resistant prostate cancer, metastasis-free survival and time to symptomatic progression were significantly longer with apalutamide than with placebo. (Funded by Janssen Research and Development; SPARTAN ClinicalTrials.gov number, NCT01946204 .).
KW - Adenocarcinoma/drug therapy
KW - Aged
KW - Aged, 80 and over
KW - Androgen Antagonists/adverse effects
KW - Disease Progression
KW - Disease-Free Survival
KW - Double-Blind Method
KW - Exanthema/chemically induced
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Metastasis/prevention & control
KW - Proportional Hazards Models
KW - Prostate-Specific Antigen
KW - Prostatic Neoplasms, Castration-Resistant/drug therapy
KW - Thiohydantoins/adverse effects
U2 - 10.1056/NEJMoa1715546
DO - 10.1056/NEJMoa1715546
M3 - Journal article
C2 - 29420164
AN - SCOPUS:85045420475
SN - 0028-4793
VL - 378
SP - 1408
EP - 1418
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 15
ER -