Evidence map›Paper›PMID 40833694›Full record

Trial reportJAMA network open2025

Statin Use in Patients With Advanced Prostate Cancer in the TITAN and SPARTAN Trials.

Soumyajit Roy, Zeynep Irem Ozay, Avirup Guha, Yilun Sun, Kim N Chi, Scott C Morgan, Shawn Malone, Christopher J D Wallis, Jason R Brown, Pedro C Barata and 9 more

Abstract readRandomized Controlled TrialClinical Trial, Phase IIIMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Navigating drug-drug interactions with apalutamide.Prostate cancer and prostatic diseases · 2026
    Review
  2. Review
  3. Article
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  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Soumyajit RoyDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Zeynep Irem OzayDepartment of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City.
Avirup GuhaCardio-Oncology Program, Georgia Cancer Center, Augusta University, Augusta, Georgia.
Yilun SunDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Kim N ChiDepartment of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada.
Scott C MorganDepartment of Radiation Oncology, Medical Physics, and Radiology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada.
Shawn MaloneDepartment of Radiation Oncology, Medical Physics, and Radiology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada.
Christopher J D WallisDivision of Urology, Mount Sinai Hospital, University Hospital Network, University of Toronto, Toronto, Ontario, Canada.
Jason R BrownDepartment of Internal Medicine Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Pedro C BarataDepartment of Internal Medicine Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Amar U KishanDepartment of Radiation Oncology, University of California, Los Angeles.
Angela Y JiaDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Nicholas G ZaorskyDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Umang SwamiDepartment of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City.
Simon ChowdhuryGuy's and St Thomas' NHS Foundation Trust and Sarah Cannon Research Institute, London, United Kingdom.
Eric J SmallDepartment of Medicine, University of California, San Francisco.
Daniel E SprattDepartment of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Fred SaadDepartment of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Neeraj AgarwalDepartment of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: The impact of statins on overall survival (OS) in patients with prostate cancer treated using intensified therapy with apalutamide is not fully understood. Objective: To determine whether statin exposure was associated with OS and grade 3 or greater cardiac adverse events (AEs) in patients treated with apalutamide. Design, Setting, and Participants: This cohort study used individual patient data from 2 multicenter phase 3 randomized clinical trials, SPARTAN (October 14, 2013, to December 15, 2016) and TITAN (December 15, 2015, to July 25, 2017). The final analysis was done on May 21, 2025. TITAN and SPARTAN randomized patients to receive androgen deprivation therapy with or without apalutamide in metastatic hormone-sensitive prostate cancer (TITAN) and nonmetastatic castration-resistant prostate cancer (SPARTAN). Exposure: Statin exposure during the assigned treatment; statin exposure could have started before and ended either during or after the assigned treatment. Main Outcomes and Measures: Inverse probability of treatment-weighted (IPTW) multivariable Cox proportional hazard regression model and covariate-adjusted OS were estimated for patients with and without statin exposure in each trial. Fine and Gray regression models were applied to determine the association of statin exposure with risk of grade 3 or greater cardiac AEs, considering deaths as competing events. Results: Among 2187 patients included in this analysis, 1288 received apalutamide (517 in TITAN; 770 in SPARTAN) and 900 received placebo. The median (IQR) age was 65 (60-70) years in TITAN and 70 (65-80) years in SPARTAN. Patients with statin exposure were older with higher body mass index, while the proportion of patients with ECOG performance status score 1 was relatively lower. Statin exposure was associated with superior OS in patients treated with apalutamide (TITAN: hazard ratio [HR], 0.53; 95% CI, 0.32-0.87; SPARTAN: HR, 0.54; 95% CI, 0.39-0.74), but not in patients who received the placebo (TITAN: HR, 0.65; 95% CI, 0.38-1.13; SPARTAN: HR, 1.16; 95% CI, 0.76-1.77). Covariate-adjusted 3-year OS among patients with vs without statins were 81% vs 67% (difference, 14% [95% CI, 5%-22%]) and 86% vs 78% (difference, 8% [95% CI, 3%-13%]) in the apalutamide-treated patients from TITAN and SPARTAN trials, respectively. Patients receiving statins had a higher risk of grade 3 or higher cardiac AEs in both apalutamide (subdistribution HR, 2.62 [95% CI, 1.35-5.08]) and placebo (subdistribution HR, 2.36 [95% CI, 0.96-5.84]) groups. Conclusions and Relevance: In this cohort study, statin exposure was associated with longer OS in patients treated with apalutamide. Statin-exposed patients had a higher risk of grade 3 or greater cardiac AEs, which may reflect their preexisting cardiovascular comorbidity.

Indexed as

Hydroxymethylglutaryl-CoA Reductase InhibitorsProstatic NeoplasmsProstatic Neoplasms, Castration-ResistantThiohydantoinsAgedAged, 80 and overAndrogen AntagonistsCohort StudiesHumansMaleMiddle AgedAndrogen AntagonistsapalutamideHydroxymethylglutaryl-CoA Reductase InhibitorsThiohydantoins

Identifiers

PMID40833694
PMCPMC12368675

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.