Perioperative Apalutamide in High-Risk Localized or Locally Advanced Prostate Cancer Reduces Risk of Metastasis and Death - Report - MDSpire
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Perioperative Apalutamide in High-Risk Localized or Locally Advanced Prostate Cancer Reduces Risk of Metastasis and Death
High-risk localized and locally advanced prostate cancer patients treated with apalutamide — a next generation neoadjuvant androgen-receptor pathway inhibitor (ARPI) — plus hormone therapy before and after prostate cancer surgery resulted in more major pathologic responses and reduced the risk of metastasis or death, meeting both primary endpoints, in an international phase 3 clinical trial led by principal investigator Mary-Ellen Taplin, MD, medical oncologist at Dana-Farber Cancer Institute, and Adam Kibel, MD, chair of the Department of Urology at Mass General Brigham.
Clinical Report: Perioperative Apalutamide Reduces Risk in Prostate Cancer
Overview
The PROTEUS trial demonstrated that apalutamide combined with hormone therapy significantly improves major pathologic responses and reduces the risk of metastasis and death in high-risk localized or locally advanced prostate cancer patients. This combination therapy resulted in a 20% reduction in the risk of metastasis or death compared to hormone therapy alone.
Background
Prostate cancer is a prevalent diagnosis, with a significant proportion classified as high-risk for relapse after standard treatments. Current therapies often fail to prevent recurrence, necessitating improved treatment strategies. The PROTEUS trial addresses this gap by evaluating the efficacy of apalutamide in a perioperative setting, potentially reshaping treatment protocols for high-risk patients.
Data Highlights
Outcome
Apalutamide + ADT
ADT Alone
5-Year Metastasis-Free Survival
78.2%
73.5%
Pathologic Complete Response
8.9%
1.0%
Risk Reduction of Metastasis or Death
20%
N/A
Delay in Subsequent Therapy
33 months
N/A
Key Findings
Apalutamide plus ADT resulted in a 20% reduced risk of metastasis or death.
Five-year metastasis-free survival was 78.2% for the combination therapy versus 73.5% for ADT alone.
Patients receiving apalutamide were nine times more likely to have little to no cancer at surgery.
8.9% of patients on apalutamide achieved a pathologic complete response compared to 1.0% on ADT alone.
The study delayed the need for subsequent therapy by 33 months.
Clinical Implications
The findings from the PROTEUS trial suggest that incorporating apalutamide into the treatment regimen for high-risk localized prostate cancer may significantly enhance patient outcomes. Clinicians should consider this combination therapy in the context of clinical trials and evolving treatment guidelines.
Conclusion
The PROTEUS trial provides compelling evidence for the use of apalutamide in high-risk localized prostate cancer, potentially altering the standard of care and improving patient prognosis.
