Dr. Saad on the Clinical Impact of Apalutamide in nmCRPC

Fred Saad, MD, FRCS, professor and chief of Urology; director of Genitourinary Oncology; Raymond Garneau Chair in Prostate Cancer, University of Montreal Hospital Center; and director ofProstate Cancer Research at Montreal Cancer Institute, discusses the impact of apalutamide (Erleada) on nonmetastatic castration-resistant prostate cancer (nmCRPC) in the phase 3 SPARTAN trial.

The results from the SPARTAN trial regarding metastases-free survival were beyond what was expected when starting the clinical trial, says Saad. As the first agent approved for the treatment of patients with high-risk nmCRPC, apalutamide completely changed the field. There is now something to offer patients who are at high risk of metastases, which was a big concern, as being in a state of limbo between having a treatment to offer or doing nothing until the patient’s disease became metastatic isn't ideal. However, no action could be taken until the field had proven that they had a useful treatment. To this end, apalutamide completely changed what the field is able to offer patients.

Questions regarding the delay of metastases as worthwhile action remain; the field wanted to see significant improvement in overall survival (OS), though this is an extremely high bar when following patients very closely, especially when starting therapy in the metastatic setting much earlier than in the real world. This is cause for cautious optimism because patients were treated very well in the SPARTAN trial and many of the therapies available in the placebo arm were able to catch up in terms of OS, concludes Saad.