Dual therapy may be preferred in older patients with metastatic castration-sensitive prostate cancer (mCSPC) who have low disease volume since triplet therapy was found to be associated with the highest risk of adverse events (AEs) despite producing the largest improvements in radiographic progression free survival (rPFS) and overall survival (OS), according to findings presented at the 2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium.
The network meta-analysis (NMA) aimed to compare various combinations of treatment options to determine the safest and most effective management strategy for mCSPC. MEDLINE, EMBASE, and conference proceedings were searched to obtain phase 2/3 randomized controlled trials (RCTs) analyzing first-line therapy options for the treatment of mCSPC. Outcomes of the analysis included OS, rPFS, and grade 3 or more AEs.
A total of 9 trials with 9 unique therapies were analyzed in the NMA. Findings of the analysis revealed an improvement in rPFS in patients who received abiraterone acetate and prednisone-docetaxel-androgen deprivation therapy combination (AAP-D-ADT; rank 1) compared with patients who received AAP-ADT (HR, 0.58; 95% CI, 0.44-0.76; rank 5), apalutamide (APA)-ADT (HR, 0.63; 95% CI, 0.46-0.87; rank 4), and enzalutamide (E)-AAP-ADT (HR, 0.70; 95% CI, 0.51-0.97; rank 3). No significant differences were observed in patients who were treated with AAP-D-ADT compared with E+ADT (rank 2).
Results of the NMA also showed that, compared with patients who received D+ADT (rank 6), those who received AAP-D-ADT (HR. 0.75; 95% CI, 0.59-0.95; rank 2), E-AAP-ADT (HR, 0.68; 95% CI, 0.48-0.97; rank 1), and AAP-ADT (HR, 0.82; 95% CI, 0.70-0.96; rank 3) had significant improvements in OS. The study authors did note, however, that statistically insignificant findings were observed in terms of OS for the majority of mixed therapy comparisons.
“Similarly, in patients with high volume of disease, AAP+D+ADT (rank 1) was observed to significantly improve rPFS compared with AAP-ADT, APA-ADT, E-ADT, and D-ADT; however, no significant differences were observed among treatment comparisons with regards to OS improvement,” the investigators reported. They added, “E+ADT (rank 1) improved rPFS compared with other treatment in low volume disease but was not different for OS.”
Additionally, when comparing across prespecified groups, no significant differences among these various therapeutic options were observed. Findings of the analysis also revealed treatment with AAP+D+ADT was associated with the highest risk of grade 3 AEs compared with other therapeutic options.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Riaz IB, Naqvi SAA, Ikram W, et al. First-line treatment options in metastatic castration-sensitive prostate cancer: A systematic review and network meta-analysis. Presented at: ASCO-GU 2022; February 17-19, 2022; Abstract 132.
This article originally appeared on MPR