Oral chemotherapeutic agents in metastatic hormone-sensitive prostate cancer: A network meta-analysis of randomized controlled trials

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY Prostate International Pub Date : 2023-09-01 DOI:10.1016/j.prnil.2023.06.003

Yong Seong Lee , Seong Hwan Kim , Jong Hyun Tae , In Ho Chang , Tae-Hyoung Kim , Soon Chul Myung , Myoungsuk Kim , Tuan Thanh Nguyen , Joongwon Choi , Jung Hoon Kim , Jin Wook Kim , Se Young Choi

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引用次数: 1

Abstract

Background

Multiple oral chemotherapeutic agents for metastatic hormone-sensitive prostate cancer (mHSPC) have been developed for conjugated use with conventional androgen deprivation therapy (ADT). Several randomized controlled trials (RCTs) report significant benefits in mHSPC patients. Therefore, we compared overall survival (OS) and progression-free survival (PFS) benefits among considerable mHSPC oral chemotherapeutic agents.

Materials and methods

We investigated mHSPC treatment efficacy through a systematic RCT-trial literature review (PubMed, Embase, Web of Science, the Cochrane Library, and Scopus). Two reviewers independently screened, extracted data, and assessed bias risk in duplicate.

Results

We identified 18 RCTs (n = 13,509). Concerning OS, ADT + abiraterone, ADT + abiraterone + docetaxel, ADT + apalutamide, ADT + bicalutamide, ADT + darolutamide + docetaxel, ADT + enzalutamide, ADT + orteronel, and ADT + rezvilutamide were more effective than the standard of care (SOC). Comparing PFS, most treatments were more effective than SOC, excluding ADT + bicalutamide, nilutamide, flutamide, ADT + bicalutamide + palbociclib, and ADT + nilutamide. ADT + docetaxel with androgen receptor targeted agent (ARTA) triplet therapy was not among the top three treatments determined through ranking analysis.

Conclusions

Novel oral chemotherapeutic agent combination therapies must replace current ADT monotherapy and ADT + docetaxel SOC. Even so, ADT + docetaxel with ARTA triplet therapy still is not the best mHSPC treatment and requires further study.

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转移性激素敏感性前列腺癌症的口服化疗药物：随机对照试验的网络荟萃分析。

背景：多种治疗转移性激素敏感性前列腺癌症（mHSPC）的口服化疗剂已被开发用于与传统雄激素剥夺疗法（ADT）联合使用。一些随机对照试验（RCT）报告了对mHSPC患者的显著益处。因此，我们比较了大量mHSPC口服化疗药物的总生存期（OS）和无进展生存期（PFS）益处。材料和方法：我们通过系统的随机对照试验文献综述（PubMed、Embase、Web of Science、Cochrane Library和Scopus）研究了mHSPC的治疗效果。两名评审员对数据进行了独立筛选、提取，并对偏倚风险进行了评估，一式两份。结果：我们确定了18个随机对照试验（n=13509）。在OS方面，ADT+阿比特龙、ADT+abiraterone+多西他赛、ADT+apalutamide、ADT+-bicalutamide、ADT+Tarlutamide+docetaxel、ADT+cenzalutamide，ADT+orteronel和ADT+rezvilutamide比标准护理（SOC）更有效。比较PFS，大多数治疗比SOC更有效，不包括ADT+bicalutamide、尼鲁他胺、氟他胺、ADT+bicalutamide+palbociclib和ADT+nilutamide。ADT+多西他赛联合雄激素受体靶向剂（ARTA）三联疗法不在通过排名分析确定的前三种治疗方法之列。结论：新的口服化疗药物联合治疗必须取代目前的ADT单药治疗和ADT+多西他赛SOC。尽管如此，ADT+多西他赛联合ARTA三联疗法仍然不是最佳的mHSPC治疗方法，需要进一步研究。

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来源期刊

Prostate International Medicine-Urology

CiteScore

4.40

自引率

26.70%

发文量

审稿时长

35 days

期刊介绍： Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...