European urology · 2026
FORMULA-509: A Multicenter Randomized Trial of Postprostatectomy Salvage Radiotherapy and 6 months of a GNRH Agonist with Either Bicalutamide or Abiraterone Acetate plus Prednisone and Apalutamide.
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Nguyen Paul L, Kollmeier Marisa A, Rathkopf Dana E, Hoffman Karen E, Zurita Amado J, Spratt Daniel E, Dess Robert T, Liauw Stanley L, Szmulewitz Russell Z, Einstein David J, Bubley Glenn J, Yu James B, An Yi, Wong Anthony C, Feng Felix Y, McKay Rana R, Rose Brent S, Shin Kee-Young, Kibel Adam S, Taplin Mary-Ellen
Аннотация
BACKGROUND AND OBJECTIVE: For patients with detectable prostate-specific antigen (PSA) after radical prostatectomy, 6 mo of a GNRH agonist with salvage radiotherapy (sRT) is a standard treatment option.
METHODS: FORMULA-509 (NCT03141671) enrolled 345 patients with PSA ≥0.1 ng/ml and high-risk features from November 24, 2017 to March 25, 2020. Patients received sRT plus 6 mo of a GNRH agonist and randomization to bicalutamide (50 mg) or abiraterone acetate + prednisone (AAP; 1000 mg/5 mg) + apalutamide (240 mg) QD. The primary endpoint was PSA progression-free survival (PFS). A secondary endpoint was metastasis-free survival (MFS) on conventional imaging. Stratification was by PSA (>0.5 vs ≤0.5 ng/ml) and pN status (pN0 vs pN1).
KEY FINDINGS AND LIMITATIONS: Median follow-up was 34 mo. AAP + apalutamide did not reach the prespecified significance level for PFS benefit in comparison to bicalutamide (hazard ratio [HR] 0.71. 90% confidence interval [CI] 0.49-1.03; stratified one-sided log-rank p = 0.063), with 3-yr PFS rates of 68.5% with bicalutamide versus 74.9% with AAP + apalutamide. The HR for MFS was 0.57 (90% CI 0.33-1.01; stratified one-sided p = 0.050) and the 3-yr MFS rates were 87.2% with bicalutamide versus 90.6% with AAP + apalutamide. A preplanned analysis by stratification factors revealed that for patients with PSA >0.5 ng/ml, AAP + apalutamide was associated with superior PFS (HR 0.50, 95% CI 0.27-0.95; 2-sided p = 0.030; 3-yr PFS 46.8% with bicalutamide vs 67.2% with AAP + apalutamide) and MFS (HR 0.32, 95% CI 0.13-0.84; 2-sided p = 0.014; 3-yr MFS 66.1% with bicalutamide vs 84.3% with AAP + apalutamide). Adverse events were consistent with the known safety profiles of the study agents, with more frequent rash and hypertension in the AAP + apalutamide arm.
CONCLUSIONS AND CLINICAL IMPLICATIONS: This study did not reveal a benefit for the overall population, but addition of AAP + apalutamide (vs bicalutamide) to sRT and ADT improved PFS and MFS in the prespecified subgroup with PSA >0.5 ng/ml.
METHODS: FORMULA-509 (NCT03141671) enrolled 345 patients with PSA ≥0.1 ng/ml and high-risk features from November 24, 2017 to March 25, 2020. Patients received sRT plus 6 mo of a GNRH agonist and randomization to bicalutamide (50 mg) or abiraterone acetate + prednisone (AAP; 1000 mg/5 mg) + apalutamide (240 mg) QD. The primary endpoint was PSA progression-free survival (PFS). A secondary endpoint was metastasis-free survival (MFS) on conventional imaging. Stratification was by PSA (>0.5 vs ≤0.5 ng/ml) and pN status (pN0 vs pN1).
KEY FINDINGS AND LIMITATIONS: Median follow-up was 34 mo. AAP + apalutamide did not reach the prespecified significance level for PFS benefit in comparison to bicalutamide (hazard ratio [HR] 0.71. 90% confidence interval [CI] 0.49-1.03; stratified one-sided log-rank p = 0.063), with 3-yr PFS rates of 68.5% with bicalutamide versus 74.9% with AAP + apalutamide. The HR for MFS was 0.57 (90% CI 0.33-1.01; stratified one-sided p = 0.050) and the 3-yr MFS rates were 87.2% with bicalutamide versus 90.6% with AAP + apalutamide. A preplanned analysis by stratification factors revealed that for patients with PSA >0.5 ng/ml, AAP + apalutamide was associated with superior PFS (HR 0.50, 95% CI 0.27-0.95; 2-sided p = 0.030; 3-yr PFS 46.8% with bicalutamide vs 67.2% with AAP + apalutamide) and MFS (HR 0.32, 95% CI 0.13-0.84; 2-sided p = 0.014; 3-yr MFS 66.1% with bicalutamide vs 84.3% with AAP + apalutamide). Adverse events were consistent with the known safety profiles of the study agents, with more frequent rash and hypertension in the AAP + apalutamide arm.
CONCLUSIONS AND CLINICAL IMPLICATIONS: This study did not reveal a benefit for the overall population, but addition of AAP + apalutamide (vs bicalutamide) to sRT and ADT improved PFS and MFS in the prespecified subgroup with PSA >0.5 ng/ml.