Abiraterone or apalutamide added to androgen deprivation therapy (ADT) for men with metastatic castration-sensitive prostate cancer (mCSPC) may provide the greatest overall survival benefit with relatively low risks for serious adverse events, according to a recent systematic review and meta-analysis.
“This study is important for patients, clinicians, and payers given the uncertainty about the optimal treatment for mCSPC, which causes significant morbidity and mortality among older men,” corresponding author Otis Brawley, MD, of Johns Hopkins University Bloomberg School of Public Health in Baltimore, Maryland, and colleagues reported in JAMA Oncology.
The meta-analysis included data from 7 clinical trials with 7287 patients comparing systemic add-on treatments to ADT (abiraterone, apalutamide, enzalutamide, docetaxel and standard nonsteroidal antiandrogens) with placebo or no treatment.
Abiraterone and apalutamide were significantly associated with a 39% and 33% decreased risk of death, respectively, compared with placebo or no treatment. Docetaxel was significantly associated with a 21% decreased risk of death, Dr Brawley’s team reported.
Enzalutamide and standard nonsteroidal antiandrogens did not significantly improve overall survival. Enzalutamide, however, offered the largest improvement in radiographic progression-free survival. It was significantly associated with a 61% decreased risk for radiographic progression compared with a 52%, 49%, and 33% decreased risk for apalutamide, abiraterone, and docetaxel, respectively, according to the investigators. Standard nonsteroidal antiandrogens did not significantly decrease radiographic progression risk.
Docetaxel was significantly associated with nearly 24-fold increased odds for serious adverse events (SAEs) compared with 1.4-fold increased odds for abiraterone. The other treatments did not significantly increase SAEs.
“This network meta-analysis suggests that abiraterone acetate and apalutamide may provide the largest and most consistent overall survival benefits with relatively low serious adverse events risks among metastatic castration-sensitive prostate cancer treatments,” the authors wrote.
Wang L, Paller CJ, Hong H, et al. Comparison of systemic treatments for metastatic castration-sensitive prostate cancer. A systematic review and network meta-analysis. Published online January 14, 2021. JAMA Oncol. doi:10.1001/jamaoncol.2020.6973