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Published on: March 6, 2018
The optimal upfront therapy in metastatic hormone-sensitive prostate cancer: A network meta-analysis
1Department of Oncology, School of Medicine, Istinye University, Istanbul, Turkey.
Background:
Prostate cancer (PC) is one of the most common cancer types in men. In addition to androgen-deprivation therapy (ADT), new generation agents have provided survival advantages to patients with metastatic hormone-sensitive PC (mHSPC). In this analysis, we aimed to determine the most effective approach for treating and suppressing mHSPC using network meta-analysis (NMA).
Materials And Methods:
A total of 10 trials investigating different treatment modalities were conducted using NMA. The analysis was performed for all mHSPC cases as well as for low- and high-volume and docetaxel-naive subgroups.
Results:
In combination with ADT, abiraterone acetate (AA) in the general-population and high-volume-disease subgroups, and enzalutamide in docetaxel-naive and low-volume-disease subgroups have the highest probability of being the best treatment modalities in terms of overall survival. In addition, in the low-volume and docetaxel-naive settings, enzalutamide was superior to ADT (hazard ratio [HR] = 0.429, 95% CrI: 0.258-0.714 and HR = 0.533, 95% CrI: 0.375-0.756, respectively). In addition, in the high-volume and general-population settings (all trials and cases), AA was superior to ADT (HR = 1.568, 95% CrI: 1.378-1.773 and HR = 1.164, 95%CrI: 1.348-1.924, respectively).
Conclusion:
The volume status based on the CHAARTED trial should be taken into account to determine an appropriate treatment strategy for mHSPC. AA plus prednisone in high-risk and high-volume-mHSPC patients and enzalutamide in low-volume-mHSPC patients could be favorable options in combination with ADT. Depending on the patient's tolerance, in high-volume mHSPC, docetaxel, or apalutamide in combination with ADT could be alternatives for AA, whereas in the low-volume mHSPC, local radiotherapy plus ADT or ADT alone could be utilized in place of enzalutamide.
Insights
For metastatic hormone-sensitive prostate cancer (mHSPC), abiraterone acetate (AA) is best for high-volume disease, while enzalutamide is preferred for low-volume or docetaxel-naive cases when combined with androgen-deprivation therapy (ADT).
Area of Science:
- Oncology
- Medical treatment efficacy
- Prostate cancer research
Background:
- Prostate cancer (PC) is a prevalent malignancy in men.
- Androgen-deprivation therapy (ADT) is a standard treatment for metastatic hormone-sensitive PC (mHSPC).
- Newer agents offer survival benefits for mHSPC patients.
Purpose of the Study:
- To determine the most effective treatment strategy for mHSPC using network meta-analysis (NMA).
- To compare the efficacy of different treatment modalities for mHSPC.
- To identify optimal therapies based on disease volume and prior treatment.
Main Methods:
- Network meta-analysis (NMA) of 10 clinical trials.
- Analysis included all mHSPC cases, low-volume, high-volume, and docetaxel-naive subgroups.
- Comparison of overall survival outcomes for various treatment combinations with ADT.
Main Results:
- Abiraterone acetate (AA) combined with ADT showed the highest probability of efficacy in general and high-volume mHSPC subgroups.
- Enzalutamide combined with ADT was most effective in docetaxel-naive and low-volume mHSPC subgroups.
- Specific hazard ratios demonstrated superiority of enzalutamide in low-volume/docetaxel-naive settings and AA in high-volume/general settings compared to ADT alone.
Conclusions:
- Disease volume, particularly based on the CHAARTED trial criteria, is crucial for selecting mHSPC treatment.
- AA plus prednisone is recommended for high-volume mHSPC, while enzalutamide is favored for low-volume mHSPC, both in combination with ADT.
- Alternative options include docetaxel or apalutamide for high-volume disease and local radiotherapy for low-volume disease, depending on patient factors.
