Clinical efficacy of apalutamide in Asian patients with metastatic castration-sensitive prostate cancer: Bayesian reanalysis of the TITAN trial
Abstract
BACKGROUND: The phase 3 TITAN trial revealed that apalutamide plus androgen deprivation therapy (ADT) has significantly improved outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC). However, the generalizability of these results to Asian and Japanese populations remains unclear. Bayesian methods provide a probabilistic framework offering more clinically meaningful estimates of benefit in such subpopulations.
METHODS: We conducted a Bayesian post hoc analysis using reconstructed individual patient data from the published Asian (n = 221) and Japanese (n = 51) TITAN trial subpopulations. Bayesian Cox proportional hazards models were fitted under four prespecified priors representing different skepticism levels. Posterior median hazard ratios (HRs), 95% credible intervals (CrIs), and probabilities of any benefit (Pr[HR < 1.0]) or substantial benefit (Pr[HR < 0.8]) were calculated.
RESULTS: The posterior median HR under the neutral prior for overall survival in the Asian cohort was 0.71 (95% CrI 0.44-1.14), with Pr[HR < 1.0] = 92% and Pr[HR < 0.8] = 69%. Probabilities exceeded 95% under more informative priors. The Japanese cohort demonstrated more pronounced effects (neutral prior HR: 0.55, 95% CrI: 0.22-1.35) with ≥90% probability of benefit across all priors. Posterior median HRs for TTmCRPC were 0.32-0.35 across priors, with ~100% probability of treatment benefit in both cohorts.
CONCLUSION: This analysis provides strengthened evidence that…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 221 participants or records.
Read the paper
Related studies
- Induced osteoblast differentiation by amide derivatives of stilbene: The possible osteogenic agents
- On model selections for repeated measurement data in clinical studies
- Regulation of GLUT transporters by flavonoids in androgen-sensitive and -insensitive prostate cancer cells
- Region-specific microRNA signatures in the human epididymis
- Synthesis, biological evaluation and molecular docking of 4-Amino-2H-benzo[h]chromen-2-one (ABO) analogs containing the piperazine moiety
- In Vitro characterization of the endocrine disrupting effects of per- and poly-fluoroalkyl substances (PFASs) on the human androgen receptor
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.