A Review of TITAN Trial for Prostate Cancer

The TITAN trial, a phase III, randomized, double-blind, placebo-controlled study, evaluated the efficacy and safety of apalutamide in combination with androgen deprivation therapy (ADT) for patients with metastatic castration-sensitive prostate cancer (mCSPC). The trial included 1,052 patients randomized to receive apalutamide or placebo plus ADT, with primary endpoints of overall survival (OS) and radiographic progression-free survival (rPFS). Results demonstrated that apalutamide significantly improved OS and rPFS, with a 35% reduction in the risk of death (HR, 0.65; 95% CI, 0.53–0.79; P<0.001) at a median follow-up of 44 months. Health-related quality of life (HRQOL) was maintained during treatment. Adverse events more common in the apalutamide group included rash (27.1%), hypothyroidism, and ischemic heart disease, but these were manageable. The TITAN trial established apalutamide plus ADT as an effective and well-tolerated treatment option for mCSPC, offering significant survival benefits while preserving quality of life.