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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Combination therapy in metastatic castration sensitive prostate cancer: A Systematic review and network meta-analysis
Jatinder Kumar1, Muhammad Umar Alam1, Seyed Behzad Jazayeri2
1Armstrong Center for Medicine and Health, Kittanning, Pennsylvania, USA.
Introduction:
Studies directly comparing the different combination therapies offered to men with metastatic castration sensitive prostate cancer (mCSPC), are not available yet. This study was designed using the network meta-analysis (NMA) framework to provide a comparison of the different available options for the treatment of men with mCSPC.
Methods:
A systematic search was performed and the prospective randomized controlled trials reporting the overall survival (OS) or failure-free survival (FFS) were selected for review. A total of 14 studies were included in the NMA.
Results:
The addition of abiraterone, apalutamide, docetaxel, and docetaxel with zoledronic acid to the androgen deprivation therapy (ADT) demonstrated a significant improvement in the OS. In indirect comparison, abiraterone had a higher impact on the OS as compared to docetaxel (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.0-1.46) and docetaxel with zoledronic acid (HR: 1.31, 95% CI: 1.05-1.63) but not apalutamide. Furthermore, apalutamide was not different than docetaxel or docetaxel with zoledronic acid. There was a significant improvement in the FFS with the combination of abiraterone, apalutamide, docetaxel (HR: 0.61, 95% CI: 0.46-0.81), docetaxel with zoledronic acid (HR: 0.62, 95% CI: 0.43-0.9), and enzalutamide (HR: 0.39, 95% CI: 0.25-0.61) as compared to the ADT alone. Similar to the indirect comparison of OS, abiraterone outperformed docetaxel (HR: 1.66, 95% CI: 1.12-2.47), docetaxel with zoledronic acid (HR: 1.69, 95% CI: 1.06-2.68), and enzalutamide (HR: 1.06, 95% CI: 0.63-1.80), but not apalutamide in terms of impact on the FFS.
Conclusion:
Overall, abiraterone demonstrated better OS and FFS outcomes as compared to all the other combination strategies in this NMA.
Insights
Abiraterone showed superior overall survival and failure-free survival in metastatic castration-sensitive prostate cancer (mCSPC) compared to other combination therapies. This network meta-analysis (NMA) provides crucial insights for mCSPC treatment strategies.
Area of Science:
- Oncology
- Pharmacology
Background:
- Metastatic castration-sensitive prostate cancer (mCSPC) treatment involves various combination therapies.
- Direct comparative studies of these therapies are limited, necessitating indirect comparisons.
Purpose of the Study:
- To compare the efficacy of different combination therapies for mCSPC using a network meta-analysis (NMA).
- To evaluate overall survival (OS) and failure-free survival (FFS) outcomes for various treatment regimens.
Main Methods:
- A systematic search of prospective randomized controlled trials was conducted.
- 14 studies were included in the NMA, focusing on trials reporting OS or FFS.
Main Results:
- Abiraterone, apalutamide, docetaxel, and docetaxel with zoledronic acid significantly improved OS when added to androgen deprivation therapy (ADT).
- Abiraterone demonstrated superior OS compared to docetaxel and docetaxel with zoledronic acid.
- Abiraterone, apalutamide, docetaxel, docetaxel with zoledronic acid, and enzalutamide significantly improved FFS compared to ADT alone.
- Abiraterone showed better FFS outcomes than docetaxel, docetaxel with zoledronic acid, and enzalutamide.
Conclusions:
- Abiraterone exhibited superior OS and FFS outcomes compared to other combination strategies in mCSPC.
- The findings support abiraterone as a highly effective treatment option for mCSPC.
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