A Bayesian Network Meta-analysis of Systemic Treatments for Metastatic Castration-Resistant Prostate Cancer in First-...

Area of Science:

• Oncology
• Clinical Trials
• Pharmacology

Background:

• Metastatic castration-resistant prostate cancer (mCRPC) treatment sequencing is complex due to limited head-to-head comparisons.
• The widespread use of androgen receptor pathway inhibitors (ARPIs) in metastatic hormone-sensitive prostate cancer (mHSPC) further complicates mCRPC treatment decisions.

Purpose of the Study:

• To conduct a Bayesian network meta-analysis (NMA) for comprehensive efficacy evaluation of mCRPC treatments.
• To compare treatment efficacy across various lines of therapy in mCRPC.

Main Methods:

• Systematic literature search of ClinicalTrials.gov.
• Bayesian network meta-analysis (NMA) for overall survival (OS) and progression-free survival (PFS).
• Adherence to PRISMA NMA guidelines and PROSPERO registration.

Main Results:

• Included 43 trials with 33,494 patients.
• ARPI-based therapies, especially with PARP inhibitors, showed significant OS and PFS benefits in first-line mCRPC.
• ARPI re-treatment had limited efficacy in subsequent lines, with reduced OS and PFS benefits.

Conclusions:

• ARPI-based therapies and chemotherapies are superior first-line options for mCRPC.
• Treatment class switching is necessary after ARPI failure in mCRPC.
• Future research should focus on individual participant data and biomarkers for personalized mCRPC therapy.