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Generation of Prostate Cancer Cell Models of Resistance to the Anti-mitotic Agent Docetaxel
Published on: September 8, 2017
Treatment of Metastatic, Castration-resistant, Docetaxel-resistant Prostate Cancer: A Systematic Review of Literature
Davide Tassinari1, Chiara Cherubini2, Britt Roudnas1
1Department of Oncology, City Hospital, Rimini, Italy.
Introduction:
To compare the efficacy of abiraterone acetate, enzalutamide, cabazitaxel and Radium-223 in the treatment of castration-resistant, docetaxel-resistant metastatic prostate cancer.
Methods:
An indirect comparison of Overall Survival (OS) and time to PSA progression among abiraterone acetate, enzalutamide, cabazitaxel and Radium-223 was performed with a network metaanalysis. OS in the entire population of patients was the primary endpoint. OS in ECOG 0-1/2, BPISF≤ 4/>4, pretreated with 1 or 2 courses of chemotherapy, age≤65/>65 patients, patients with only bone metastases or bone and visceral metastases, and time to PSA progression were the secondary endpoints. An indirect comparison of the Hazard Ratio and the 95% Confidence Interval was performed, assuming an alpha error of 5% as an index of statistical significance. The among-the-trial heterogeneity was assessed using a qualitative methodological and clinical analysis.
Results:
Four trials were selected. In three trials, the comparator was placebo, in one trial it was mitoxantrone, the effect of which in improving survival was considered negligible. No significant difference in OS among abiraterone acetate, enzalutamide, cabazitaxel and radium 223 was observed in neither the entire population nor all the subgroups of patients. Enzalutamide resulted significantly better than abiraterone acetate, cabazitaxel or radium-223 in time to PSA progression.
Conclusion:
Since no significant difference in efficacy seems to exist between the four therapeutic options in the treatment of castration-resistant, docetaxel-resistant, metastatic prostate cancer, the safety of the treatment, patient's compliance and costs should represent the criteria to guide clinicians' choice in clinical practice.
Insights
No significant difference in overall survival was found between abiraterone acetate, enzalutamide, cabazitaxel, and Radium-223 for metastatic prostate cancer. Enzalutamide showed a benefit in time to PSA progression.
Area of Science:
- Oncology
- Medical Research
- Clinical Trials
Background:
- Investigating advanced treatments for metastatic prostate cancer.
- Focusing on castration-resistant and docetaxel-resistant disease stages.
Purpose of the Study:
- To compare the efficacy of four key treatments: abiraterone acetate, enzalutamide, cabazitaxel, and Radium-223.
- To evaluate overall survival and time to prostate-specific antigen (PSA) progression.
Main Methods:
- Conducted a network meta-analysis of indirect comparisons.
- Primary endpoint: Overall Survival (OS) in the entire patient population.
- Secondary endpoints included subgroup analyses and time to PSA progression.
Main Results:
- No statistically significant difference in OS was observed among the four treatments in the overall population or subgroups.
- Enzalutamide demonstrated a significant advantage over abiraterone acetate, cabazitaxel, and Radium-223 for time to PSA progression.
Conclusions:
- The four therapeutic options show comparable efficacy in terms of overall survival for advanced prostate cancer.
- Clinical decisions should prioritize treatment safety, patient adherence, and cost-effectiveness.
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