Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer

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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.).


  • Kim N Chi
  • Neeraj Agarwal
  • Anders Bjartell
  • Byung Ha Chung
  • Andrea J Pereira de Santana Gomes
  • Robert Given
  • Álvaro Juárez Soto
  • Axel S Merseburger
  • Mustafa Özgüroğlu
  • Hirotsugu Uemura
  • Dingwei Ye
  • Kris Deprince
  • Vahid Naini
  • Jinhui Li
  • Shinta Cheng
  • Margaret K Yu
  • Ke Zhang
  • Julie S Larsen
  • Sharon McCarthy
  • Simon Chowdhury
  • TITAN Investigators
External organisations
  • Vancouver Prostate Centre
  • University of Utah
  • Huntsman Cancer Institute
  • Skåne University Hospital
  • Yonsei University
  • Liga Norte Riograndense Contra o Câncer
  • Eastern Virginia Medical School
  • Hospital Universitario de Jerez de la Frontera
  • University Medical Center Schleswig-Holstein Campus Lubeck
  • Istanbul University
  • Kindai University Hospital
  • Fudan University Shanghai Cancer Center (FUSCC)
  • Janssen Pharmaceuticals, US
  • Sarah Cannon Research Institute
  • St Thomas' Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

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

Bibliographic note

Copyright © 2019 Massachusetts Medical Society.