Abstract 202P
Background
The treatment landscape of metastatic castration-sensitive prostate cancer (mCSPC) has evolved rapidly over past few years. Following publications of several large-scale randomised controlled trials (RCTs) Abiraterone (AA) and Docetaxel (DOC), in addition to androgen deprivation therapy (ADT) have been approved as first line therapies for high risk and high volume mCSPC respectively. In 2019, the picture is further complicated by positive results from TITAN, ENZAMET and ARCHES studies. Both Apalutamide (APA) and Enzalutamide (EZA) have been shown to be superior to placebo (plus ADT) in mCSPC. However, no head to head comparison has been made for these four drugs in first line treatment. We therefore conducted a network meta-analysis to guide the selection of best first line therapy for mCSPC.
Methods
A systematic review of RCTs of AA-/ADT-/APA-/DOC-/EZA-containing treatment regimens in newly diagnosed patients with mCSPC identified seven RCTs. (STAMPEDE arm C and arm G, CHARRTED, GETUG-AFU 15 and LATITUDE, TITAN, ENZAMET and ARCHES trials). We conducted a network meta-analysis with random-effects model under frequentist framework. The reported hazard ratios for overall survival (OS) and progression-free survival (PFS) were incorporated into the model. We used P score to rank the treatments. Treatments having higher P scores are suggested to be more preferred.
Results
Comparing with ADT alone, the hazard ratio (HR) for OS ranged from 0.62 to 0.77 with a highest P score of 0.85 for AA+ADT. For PFS, the HR ranged between 0.38 to 0.63. P Score is again highest at 0.38 for AA+ADT. As exploratory analyses, we compare the OS and PFS of AA +ADT, ENZ+ADT and APA+ADT against DOC +ADT. For OS, HR for AA+ADT is 0.8 while HR for ENZ+ADT and APA +ADT are not statistically significant. For PFS, HR for both ENZ+ADT and AA+ADT are significant (0.62 and 0.61 respectively). AA+ADT has a higher P score than ENZ (0.84 versus 0.81).
Conclusions
Our findings suggest that AA + ADT appears to be more effective than APA-ADT, DOC + ADT, and ENZ+ADT in reducing the risk of death in men with mCSPC and preventing disease progression. This network meta-analysis provides useful guidance to clinicians in choosing the first line therapy in mCSPC patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
87P - Negative to positive lymph node ratio-prognostic marker of survival in node positive rectal cancer
Presenter: Pavan Jonnada
Session: Poster display session
Resources:
Abstract
88P - The Sidra LUMC advanced colon cancer NGS cohort
Presenter: Wouter Hendrickx
Session: Poster display session
Resources:
Abstract
89P - A phase II trial of adjuvant chemoradiotherapy for patients with high-risk rectal submucosal invasive cancer after local resection
Presenter: Masaaki Noguchi
Session: Poster display session
Resources:
Abstract
90P - High MICB expression confers prognostic benefit in colorectal cancer
Presenter: Shanchao Yu
Session: Poster display session
Resources:
Abstract
91P - Adjuvant therapy for high-risk stage II or stage III colon adenocarcinoma: A propensity score-matched, nationwide, population-based cohort study
Presenter: Chien-Hsin Chen
Session: Poster display session
Resources:
Abstract
92P - Prospective randomized controlled study comparing primary surgery versus neoadjuvant chemotherapy followed by surgery in gastric carcinoma
Presenter: Vipin Goel
Session: Poster display session
Resources:
Abstract
93P - Biomarker selection of liver metastatic colorectal patients for anti-EGFR monoclonal antibodies: A machine learning analysis
Presenter: Yijiao Chen
Session: Poster display session
Resources:
Abstract
94P - NORTH/HGCSG1003: North Japan multicenter phase II study of oxaliplatin-containing regimen as adjuvant chemotherapy for stage III colon cancer: Final analysis
Presenter: Michio Nakamura
Session: Poster display session
Resources:
Abstract
95P - Anatomical resections improve relapse-free survival in patients with KRAS/NRAS/BRAF- mutated colorectal liver metastases
Presenter: Ye Wei
Session: Poster display session
Resources:
Abstract
96P - Incidence, characteristics and prognosis in colorectal cancer with CNS metastases
Presenter: Nicola Taylor
Session: Poster display session
Resources:
Abstract