First-line systemic therapy for metastatic castration-sensitive prostate cancer: An updated systematic review with novel findings. (January 2021)

• Record Type: Journal Article
• Authors: Ferro, Matteo; Lucarelli, Giuseppe; Crocetto, Felice; Dolce, Pasquale; Verde, Antonio; La Civita, Evelina; Zappavigna, Silvia; de Cobelli, Ottavio; Di Lorenzo, Giuseppe; Facchini, Bianca Arianna; Scafuri, Luca; Onofrio, Livia; Porreca, Angelo; Busetto, Gian Maria; Sonpavde, Guru; Caraglia, Michele; Klain, Michele; Terracciano, Daniela; De Placido, Sabino; Buonerba, Carlo
• Is Part Of: Critical reviews in oncology/hematology. Volume 157(2021)
• Publication Date: 2021-01
• Subjects: Castration-sensitive prostate cancer -- Abiraterone -- Enzalutamide -- Apalutamide; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2020.103198
• Languages: English
• ISSNs: 1040-8428

Abstract

Graphical abstract: Abstract: Although both docetaxel and androgen-receptor-axis-targeted (ARAT) agents have yielded survival improvements in combination with androgen deprivation therapy (ADT) compared to ADT alone in metastatic castration-sensitive prostate cancer (mCSPC) patients, the optimal therapeutic choice remains to be established. We analyzed estimates of the hazard ratios for death (OS-HRs) in patients treated in the first-line setting enrolled in the GETUG-AFU15, CHAARTED, STAMPEDE, LATITUDE, ENZAMET, and TITAN trials. Overall, men with mCSPC receiving ADT with vs. without either an ARAT agent or docetaxel as first-line systemic therapy showed a pooled OS-HR of 0.69 (95 % CI: 0.61−0.78), with significant heterogeneity (p = 0.045, I 2 = 52.5 %). Network meta-analysis showed an OS-HR in patients receiving an ARAT agent vs. docetaxel of 0.78 (95 %CI: 0.67−0.91). In conclusion, the evidence analysed indicates that an ARAT agent may provide improved OS outcomes compared to docetaxel. Prospective randomized trials are warranted.