Abstract 652P
Background
We conducted this systematic review and network meta-analysis aiming to compare the efficacy and safety of current systemic combination therapies for patients with metastatic hormone-sensitive prostate cancer (mHSPC) and help select candidates for optimal treatment.
Methods
Databases of MEDLINE (1966 to 2019.10) and EMBASE (1974 to 2019.10), Cochrane Central Register of Controlled Trials (CENTRAL) (1948-2019.10) and Clinical Trial.gov (1999-2019.10) were searched for eligible studies. Direct and network meta-analysis were conducted to compare various systemic combination therapies and the surface under the cumulative ranking curve (SUCRA) was generated for treatment ranking. Subgroup analyses were performed according to the extent of metastasis. Adverse events (AEs) were compared among the effective treatments.
Results
Ten trials were included in this network meta-analysis. Direct and network meta-analysis consistently suggested that androgen-deprivation therapy (ADT) combined with docetaxel, abiraterone, enzalutamide or apalutamide could significantly improve overall survival (OS) and failure-free survival (FFS) compared to ADT alone in men with mHSPC. SUCRA analysis demonstrated the superiority of ADT plus abiraterone or enzalutamide over other therapies. Subgroup analyses indicated that additional abiraterone to ADT had the highest ranking in patients with high-volume diseases or visceral metastases and enzalutamide plus ADT outperformed other treatments in patients with low-volume diseases or without visceral metastases. Different combination therapies had variable AE profiles and ADT in addition with docetaxel or abiraterone had the highest risk of AEs.
Conclusions
ADT plus docetaxel, abiraterone, enzalutamide or apalutamide were associated with significantly improved survival in patients with mHSPC. ADT plus abiraterone or enzalutamide appeared to be the most effective treatments. Clinicians should balance the efficacy, potential AEs and disease status to select the optimal treatment.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Hao Zeng.
Funding
National Natural Science Foundation of China.
Disclosure
All authors have declared no conflicts of interest.