To compare efficacy of abiraterone, enzalutamide, cabazitaxel and Ra-223 in the treatment of patients with ACRDRPC.
An indirect comparison of the efficacy of abiraterone, enzalutamide, cabazitaxel and Ra-223 was performed. The indirect comparison and the network meta-analysis were performed on data extracted from abiraterone, enzalutamide and Ra-223 vs placebo, and cabazitaxel vs mitoxantrone-prednisone comparisons in the treatment of ACRDRPC. Overall Survival (OS) was the primary end point, Time to PSA progression (TTP-PSA) the secondary one. The results of indirect comparisons were reported as Hazard Ratio and 95% Confidence Interval, assuming an alpha error of 5% as index of statistical significance.
The outcome of 4070 patients were analyzed. 378 were treated with cabazitaxel, 797 with abiraterone, 800 with enzalutamide, 614 with Ra-223, 377 with mitoxantrone and 1104 with placebo. No significant differences were observed for OS in all the indirect comparisons, while a significant improve in favor of enzalutamide was observed in TTP-PSA when compared with abiraterone, cabazitaxel or Ra-223, as detailed in the table.
|OS (Y vs X)||Ra-223 (X)||Cabazitaxel (X)||Enzalutamide (X)|
|Abiraterone (Y)||0.886 (0.672-1.167)||0.861 (0.615-1.205)||1.107 (0.827-1.482)|
|Enzalutamide (Y)||0.8 (0.61-1.049)||0.778 (0.558-1.084)|
|Cabazitaxel (Y)||1.029 (0.748-1.414)|
|TTP(PSA) (Y vs X)||Ra-223 (X)||Cabazitaxel (X)||Enzalutamide (X)|
|Abiraterone (Y)||0.906 (0.679-1.209)||0.784 (0.598-1.028)||2.339 (1.73-3.161)*|
|Enzalutamide (Y)||0.338 (0.286-0.526)*||0.335 (0.262-0.429)*|
|Cabazitaxel (Y)||1.156 (0.918-1.457)|
Abiraterone, enzalutamide, cabazitaxel and Ra-223 can be considered comparable in terms of OS in ACRDRPC, while enzalutamide seems to be superior in terms of TTP-PSA when compared with all the other comparators. On the basis of these data, the better safety profile, the patient's compliance or pharmacoeconomic considerations should guide clinicians in daily clinical practice.
Clinical trial identification
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All authors have declared no conflicts of interest.