Abstract 680P
Background
For many years Docetaxel has been the standard of care in patients with mHSPC. Several randomized studies since demonstrated the superior efficacy of novel anti-androgen compounds when added to androgen deprivation therapy (ADT) in first-line compared to ADT alone. This analysis was conducted to update and expand our existing knowledge of the relative efficacy and adverse events of the available first-line therapeutic compounds in patients with mHSPC.
Methods
A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) English language, (ii) diagnosis of mHSPC, (iii) randomized studies comparing first-line ADT alone versus its combination with Docetaxel (DOC), Abiraterone (ABI), Enzalutamide (ENZ), or Apalutamide (APA), and (iv) randomized studies reporting survival rates and grade ≥3 adverse events of the comparative arms. A frequentists network meta-analysis was conducted using netmeta package and random-effects model.
Results
Seven studies comprising a total of 9,430 participants were included. First-line ADT in combination with DOC, ABI, ENZ, and APA demonstrated significant survival advantage over ADT alone. Using relative risk of death for analysis, ADT combinations involving ENZ ranked the lowest followed by those with APA, ABI, and DOC in increasing order. Furthermore, analysis of the data using relative risk for grade ≥3 adverse events revealed that DOC had the highest followed by ABI, ENZ, APA, and ADT in decreasing order. While ADT and the androgen receptor inhibitors, APA and ENZ, demonstrated a statistically significant lower grade ≥3 adverse events when compared to DOC, the CYP17 inhibitor, ABI, had a none significant trend. Inconsistency analyses did not reveal any significant differences between direct and indirect estimates.
Conclusions
This updated network meta-analysis is the first to compare and rank the most recent first-line treatment modalities in mHSPC. It indicates that first-line ADT combinations with novel antiandrogen compounds are at least as good as DOC when it comes to survival in patients with mHSPC with better grade ≥3 adverse events profile.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Philip A. Haddad, MD.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.