nmCRPC: Therapy Evolution and Future

Matthew R. Smith, MD, PhD:So, with the approval of apalutamide on February 14, 2018, I see it as a new standard of care for nonmetastatic CRPC. And that, and any subsequently approved therapies, I think really will define this treatment landscape in that setting. These drugs, apalutamide in particular, have been shown to improve metastasis-free survival and have strong supportive evidence from secondary endpoints. I think this will be very attractive to patients and physicians to intervene in this setting and to delay or prevent the development in metastases, which is the main driver behind patient suffering and death from prostate cancer.

The SPARTAN study was the first pivotal study of apalutamide in patients with prostate cancer. There are 3 other large randomized controlled trials that are ongoing. The TITAN study is a randomized controlled trial of apalutamide in men with hormone-sensitive metastatic prostate cancer. The ASICS study is a randomized controlled trial of abiraterone acetate with or without apalutamide in men with metastatic CRPC. And the ATLAS trial is a randomized controlled trial of androgen deprivation therapy plus radiation, with or without apalutamide, in men with high-risk locally advanced prostate cancer.

So, the SPARTAN study has established apalutamide as the standard of care in nonmetastatic CRPC. But with this broad development path, including the ATLAS, ASICS, and TITAN studies, I see the future as apalutamide being an important part of the management across the entire spectrum of prostate cancer.

Transcript edited for clarity.