ASCO 2023 | STARTAR: ADT with apalutamide, radiation therapy and docetaxel in prostate cancer

So STARTAR was a multi-site investigator led trial that I did while I was at Duke. The premise of STARTAR was trying to intensify treatment in the salvage setting for biochemical recurrence of prostate cancer. And we previously had done a investigator led trial of ADT plus enzalutamide with radiation in that PSA recurrence setting, where the PSA progression free survival at three years was 53%. So the premise and the rationale for generating starter was if we intensify more treatment upfront, can we also improve that 53% to a higher potentially over 70%? And so we we did that.

We ran a trial with nine months total of treatment in the high risk biochemical recurrence setting. And we found we treated patients with nine months of hormone deprivation, with apalutamide, the androgen receptor antagonist, and then radiation an and after radiation, they subsequently received six cycles of docetaxel. And what we found was that the three year PSA progression free survival rate was 73%. And we met our metrics of improving that historic bar.

Now, in in context, in the last few months, there was another trial that read out in the similar setting, also showing three year PSA progression free survival at about 74%. So we’re very comparable in that salvage setting. So the premise was if we can intensify treatment upfront, maybe people can get away with a shorter course, but more intense treatment. And of note at our three year follow up, all but one patient had recovered their testosterone levels. So we were achieving these PSA progression free intervals with full testosterone recovery. So I think that’s really meaningful for prostate cancer.