Pharmacotherapy plan for metastatic hormone-sensitive prostate cancer:a network meta-analysis
OBJECTIVE To determine the optimal therapeutic plan for metastatic hormone-sensitive prostate cancer(mHSPC),and to provide reference for clinical decision-making.METHODS Retrieved from Medline,Embase,BIOSIS preview,the Cochrane Library and ClinicalTrials.gov systematically,randomized controlled trials about mHSPC therapy,with overall survival(OS)and radiographic progression-free survival(rPFS)as efficacy outcomes and the incidence of serious adverse events(SAEs)as safety outcome,were collected during the inception-Mar.2022.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias for the included study before conducting a Bayesian network meta-analysis.RESULTS Eight studies with 9 437 patients were finally included.The effectiveness and safety of 7 therapy plans were compared[abiraterone acetate,apalutamide,darolutamide+docetaxel,docetaxel,enzalutamide,standard non-steroidal antiandrogen(SNA)in addition to ADT,and ADT alone].In terms of efficacy index,the most beneficial regimen(except for ADT+SNA)for OS was ADT+darolutamide+docetaxel(HR=0.54,95%CI of 0.44-0.66),followed by ADT+abiraterone acetate(HR=0.64,95%CI of 0.57-0.71),apalutamide(HR=0.65,95%CI of 0.53-0.79),enzalutamide(HR=0.66,95%CI of 0.53-0.82);the least beneficial regimen for OS was ADT+docetaxel(HR=0.79,95%CI of 0.71-0.88).The most beneficial regimen(except for ADT+SNA)for rPFS was ADT+enzalutamide(HR=0.39,95%CI of 0.30-0.50),followed by ADT+apalutamide(HR=0.48,95%CI of 0.39-0.60),abiraterone acetate(HR=0.57,95%CI of 0.51-0.64),docetaxel(HR=0.62,95%CI of 0.56-0.69).The results of the tumor-loading subgroup analysis were the same.In terms of safety,ADT+darolutamide+docetaxel(OR=25.86,95%CI of 14.08-51.33),and ADT+docetaxel(OR=23.35,95%CI of 13.26-44.81)were associated with markedly increased SAEs;the incidence of SAEs caused by ADT+abiraterone acetate(OR=1.42,95%CI of 1.10-1.82)was slightly increased,and those of other therapy plans had no significant difference.CONCLUSIONS Compared with ADT alone,ADT+ darolutamide+docetaxel may provide the most significant OS benefit,but the incidence of SAEs is increased greatly;compared with ADT+docetaxel,ADT+abiraterone acetate,apalutamide or enzalutamide provide more OS benefits.ADT+enzalutamide provide optimal rPFS benefits with no increased SAEs.
国家科技期刊平台
NSTL
万方数据
维普
