Apalutamide for metastatic, castration-sensitive prostate cancer

Kim N. Chi, Neeraj Agarwal, Anders Bjartell, Byung Ha Chung, Andrea J.Pereira De Santana Gomes, Robert Given, Alvaro Juarez Soto, Axel S. Merseburger, Mustafa Ozguroglu, Hirotsugu Uemura, Dingwei Ye, Kris Deprince, Vahid Naini, Jinhui Li, Shinta Cheng, Margaret K. Yu, Ke Zhang, Julie S. Larsen, Sharon Mccarthy, Simon Chowdhury

Research output: Contribution to journalArticlepeer-review

629 Citations (Scopus)


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 followup, 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 sideeffect profile did not differ substantially between the two groups. (Funded by Janssen Research and Development; TITAN ClinicalTrials.gov number, NCT02489318.)

Original languageEnglish
Pages (from-to)13-24
Number of pages12
JournalNew England Journal of Medicine
Issue number1
Publication statusPublished - 2019 Jul 4

Bibliographical note

Funding Information:
Supported by Janssen Research and Development. Funding for editorial assistance was provided by Janssen Global Services.

Publisher Copyright:
Copyright © 2019 Massachusetts Medical Society.

All Science Journal Classification (ASJC) codes

  • Medicine(all)


Dive into the research topics of 'Apalutamide for metastatic, castration-sensitive prostate cancer'. Together they form a unique fingerprint.

Cite this