Combined androgen blockade (CAB) is one of the therapies for advanced prostate cancer. In this analysis, we compared the efficacy and safety of first-line CAB with castration monotherapy in advanced prostate cancer patients.
The meta-analysis was PRISMA compliant and was registered in PROSPERO (CRD42016054301). We searched PubMed, EMBASE, Cochrane and Scholar for randomized controlled trials (RCTs) published through 12th December 2016 and compared efficacy and safety of first line CAB vs. luteinizing hormone releasing hormone agonists (LHRHa) monotherapy/orchiectomy in advanced prostate cancer. Overall survival (OS) and progression free survival (PFS) were the primary outcomes (fixed/random effects model). Safety was the secondary outcome. Sub-group analyses included: i) Eastern vs. Western patients; ii) non-steroidal anti-androgen (NSAA) vs. steroidal anti-androgen (SAA). Studies with reported HR/presenting median survival and JADAD score >2 were included.
We identified 16 studies (6084 patients; West-12; East-4) for inclusion. CAB treatment significantly improved the OS (14 RCTS; HR 0.90; 95% CI 0.84 to 0.97, P = 0.003) and PFS (13 RCTs; HR 0.89; 95% CI 0.80 to 1.00, P = 0.04) in advanced prostate cancer patients, compared with monotherapy. No significant difference in OS (P = 0.71) and PFS (P = 0.49) was observed between Western vs. Eastern patients. CAB with NSAA significantly improved OS (HR 0.88; 95% CI 0.82 to 0.95, P = 0.0009) and PFS (HR 0.85; 95% CI 0.73 to 0.98, P = 0.007); whereas, CAB with SAA reported similar OS (HR 1.03; 95% CI 0.86 to 1.25, P = 0.74) or PFS (HR 1.01; 95% CI 0.87 to 1.17, P = 0.74) compared with castration monotherapy. Incidence of grade 3 or 4 AEs was not significantly different between CAB and castration monotherapy (P = 0.1083).
First-line CAB therapy significantly improved OS and PFS in advanced prostate cancer patients, with no significant difference in grade 3 or 4 AEs compared with castration monotherapy.
Clinical trial identification
Legal entity responsible for the study
Shanghai Changhai Hospital. 168 Changhai Road, Shanghai 200433, China
All authors have declared no conflicts of interest.