SPARTAN: Apalutamide benefit seen for luminal, basal nonmetastatic CRPC
medwireNews: Supplementing androgen deprivation therapy (ADT) with apalutamide improves metastasis-free survival (MFS) in patients with the luminal and basal subtypes of nonmetastatic castration-resistant prostate cancer (CRPC), indicates an analysis of the randomized SPARTAN trial.
However, men with the luminal subtype appeared to derive a significantly greater benefit with apalutamide than those with the basal subtype, presenter Shibu Thomas (Janssen Research & Development, Spring House, Pennsylvania, USA) pointed out at the AACR Annual Meeting 2019 in Atlanta, Georgia, USA.
In the exploratory analysis comprising 233 of the 1207 participants of the trial, MFS was significantly longer with the addition of apalutamide 240 mg/day than placebo to ADT regardless of whether individuals had the luminal B or A (35%) or basal (65%) subtype, with hazard ratios (HRs) for metastasis or death of 0.22 and 0.34, respectively, in favor of the androgen receptor inhibitor. These values were similar to the HR of 0.28 in the overall trial population.
But a comparison of just the 154 apalutamide-treated patients showed that the luminal subgroup was a significant 60% more likely to remain metastasis-free relative to the basal subgroup.
Thomas concluded that the “basal subtype is insensitive to ADT and represents an unmet need” that might be fulfilled by the addition of apalutamide to ADT, but he stressed the requirement for “further evaluation of treatment intensification” in these patients.
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