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Published on: March 6, 2018
Systemic therapies for high-volume metastatic hormone-sensitive prostate cancer: a network meta-analysis
Zhonghan Zhou1, Shuai Liu1, Jingchang Mei1
1Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Background:
We compared the effectiveness of currently available systemic therapies for high-volume metastatic hormone-sensitive prostate cancer (mHSPC) and aimed to establish the optimal treatment regimen.
Material And Methods:
We searched multiple databases for randomized controlled trials (RCTs) that evaluated the efficacy of systemic therapy in patients with high-volume mHSPC. Bayesian network meta-analysis was used to indirectly compare overall survival (OS) and progression-free survival (PFS) of various systemic therapies.
Results:
Eleven RCTs (6708 participants) finally met the eligibility criteria. Compared with androgen deprivation therapy (ADT) alone, rezvilutamide (REZ) [hazard ratio (HR) = 0.58, 95% confidence interval (CI): 0.44-0.77], abiraterone (ABI) (HR = 0.61, 95% CI: 0.53-0.71), apalutamide (APA) (HR = 0.70, 95% CI: 0.56-0.88), enzalutamide (ENZ) (HR = 0.65, 95% CI: 0.53-0.80), docetaxel (DOC) (HR = 0.72, 95% CI: 0.63-0.84), darolutamide (DAR) + DOC (HR = 0.49, 95% CI: 0.39-0.62), and ABI + DOC (HR = 0.52, 95% CI: 0.38-0.71) significantly improved OS in patients with high-volume mHSPC. Compared with DOC, no advantages were observed for doublet therapies, including REZ, ABI, APA, and ENZ on the basis of ADT, whereas DAR + DOC (HR = 0.68, 95% CI: 0.57-0.82) and ABI + DOC (HR = 0.72, 95% CI: 0.55-0.95) was associated with better OS. The ranking analysis showed that triplet therapy (DAR + DOC + ADT and ABI + DOC + ADT) had the greatest improvement in OS, followed by REZ + ADT. All the regimens showed improved PFS in patients with high-volume mHSPC. Compared with DOC, significant differences were detected for DAR + DOC, ABI + DOC, ENZ + DOC, REZ, and ENZ. According to the ranking analysis, triplet therapy ranked first, followed by ENZ and REZ.
Conclusions:
REZ + ADT were the highest ranked doublet therapy for improvement in OS of patients with high-volume mHSPC, second only to triplet therapy (DAR + DOC + ADT and ABI + DOC + ADT).
Insights
Triplet therapy, including darolutamide or abiraterone plus docetaxel and androgen deprivation therapy (ADT), offers the best overall survival for high-volume metastatic hormone-sensitive prostate cancer (mHSPC). Rezvilutamide plus ADT is a highly ranked doublet therapy option.
Area of Science:
- Oncology
- Medical Science
- Clinical Trials
Background:
- High-volume metastatic hormone-sensitive prostate cancer (mHSPC) requires effective systemic therapies.
- Optimizing treatment regimens is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the effectiveness of available systemic therapies for high-volume mHSPC.
- To determine the optimal treatment strategy for this patient population.
Main Methods:
- A systematic literature search was conducted for randomized controlled trials (RCTs) in high-volume mHSPC.
- Bayesian network meta-analysis was employed to compare overall survival (OS) and progression-free survival (PFS).
Main Results:
- Triplet therapies (darolutamide + docetaxel + ADT and abiraterone + docetaxel + ADT) demonstrated the greatest OS improvement.
- Rezvilutamide + ADT was the highest-ranked doublet therapy for OS, followed by triplet therapies.
- All evaluated regimens improved PFS; triplet therapies ranked highest, followed by enzalutamide and rezvilutamide.
Conclusions:
- Triplet therapy regimens (DAR+DOC+ADT and ABI+DOC+ADT) provide the most significant OS benefit in high-volume mHSPC.
- Rezvilutamide + ADT is a leading doublet therapy option for improving OS in this patient group.
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