# SPARTAN: apalutamide for non-metastatic castration-resistant prostate cancer

Source: https://onco.cc/key-papers/paper-spartan-nejm-2018/  
OnCo record `paper-spartan-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In men whose PSA was rising rapidly on hormone therapy but who had no visible metastases, apalutamide delayed the appearance of metastases by two years and later showed a survival benefit.

## Summary

Phase 3 placebo-controlled trial of 1,207 men with non-metastatic castration-resistant prostate cancer and PSA doubling time of ten months or less randomised 2:1 to apalutamide or placebo with continued androgen deprivation.

Median metastasis-free survival was 40.5 versus 16.2 months (hazard ratio 0.28), and the final analysis showed median overall survival of 73.9 versus 59.9 months (hazard ratio 0.78); rash, fracture and hypothyroidism were more common with apalutamide.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1715546
- Authors: Smith MR, Saad F, Chowdhury S, et al.
- Findings: Median metastasis-free survival 40.5 vs 16.2 months; hazard ratio 0.28.; Median overall survival 73.9 vs 59.9 months; hazard ratio 0.78.
- What it means: Apalutamide, enzalutamide or darolutamide are standard for high-risk non-metastatic castration-resistant prostate cancer, a setting largely defined by conventional imaging.
- Caveats: Most of these men would show metastases on PSMA PET.; Rash in about a quarter of patients.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1715546
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29420164/

## Connected records

- cancers: [Non-metastatic castration-resistant prostate cancer](https://onco.cc/cancers/prostate-nmcrpc/)
- drugs: [Apalutamide](https://onco.cc/drugs/apalutamide/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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