Center of Urology, Southwest hospital Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
J Cancer Res Clin Oncol. 2018 Sep;144(9):1751-1768. doi: 10.1007/s00432-018-2664-y. Epub 2018 May 24.
Castration-resistant prostate cancer (CRPC) refers to prostate cancer that has progressed after initial androgen deprivation therapy (ADT). Over the years, treatment strategies for metastatic CRPC (mCRPC) have undergone considerable changes. We performed a network meta-analysis to assess the effectiveness and tolerability of targeted agents for mCRPC.
We search databases including MEDLINE, EMBASE, and the Cochrane Library through Sep 5, 2017. The major effectiveness outcomes were progression-free survival (PFS) and overall survival (OS). The tolerability outcome was severe adverse events (AEs) of grade ≥ 3.
Twenty-six articles assessing a total of 20,314 patients were included in this study. A random-effect analysis showed that targeted agents could significant prolong PFS in mCRPC patients (I = 94.3%; hazard ratio (HR): 0.74; 95% confidence interval (CI): 0.65-0.84; p < 0.001). In addition, the surface under the cumulative ranking curve (SUCRA) ranking from the network analysis showed that enzalutamide was the most effective in improving the PFS of mCRPC patients (100%), followed by abiraterone (90.1%) and tasquinimod (84.2%). Additionally, targeted agents could clearly prolong OS in mCRPC patients (I = 71.6%; HR: 0.91; 95% CI: 0.85-0.97; p < 0.001). Furthermore, based on SUCRA ranking, enzalutamide was the most effective in improving the OS of mCRPC patients (97.2%), followed by abiraterone (91.1%) and zibotentan (65.8%). Intetumumab was associated with the lowest incidence of severe AEs (94.9%), followed by atrasentan (85.1%) and placebo (79.3%).
In patients with mCRPC, enzalutamide, abiraterone and tasquinimod can prolong PFS, and enzalutamide and abiraterone can prolong OS. Additionally, enzalutamide and abiraterone can improve both PFS and OS with a low risk of causing severe AEs.
去势抵抗性前列腺癌（CRPC）是指在初始雄激素剥夺治疗（ADT）后进展的前列腺癌。多年来，转移性 CRPC（mCRPC）的治疗策略发生了重大变化。我们进行了一项网络荟萃分析，以评估 mCRPC 的靶向药物的有效性和耐受性。
我们通过 Sep 5, 2017 检索了包括 MEDLINE、EMBASE 和 Cochrane 图书馆在内的数据库。主要有效性结果是无进展生存期（PFS）和总生存期（OS）。耐受性结果是≥3 级的严重不良事件（AE）。
共有 26 篇文章评估了 20314 例患者，纳入本研究。随机效应分析显示，靶向药物可显著延长 mCRPC 患者的 PFS（I = 94.3%；风险比（HR）：0.74；95%置信区间（CI）：0.65-0.84；p < 0.001）。此外，网络分析的累积排序曲线下面积（SUCRA）排名表明，恩杂鲁胺在改善 mCRPC 患者的 PFS 方面最为有效（100%），其次是阿比特龙（90.1%）和他昔莫芬（84.2%）。此外，靶向药物可明显延长 mCRPC 患者的 OS（I = 71.6%；HR：0.91；95%CI：0.85-0.97；p < 0.001）。此外，基于 SUCRA 排名，恩杂鲁胺在改善 mCRPC 患者的 OS 方面最为有效（97.2%），其次是阿比特龙（91.1%）和齐伯腾（65.8%）。英特单抗的严重不良事件发生率最低（94.9%），其次是阿托生坦（85.1%）和安慰剂（79.3%）。
在 mCRPC 患者中，恩杂鲁胺、阿比特龙和他昔莫芬可延长 PFS，恩杂鲁胺和阿比特龙可延长 OS。此外，恩杂鲁胺和阿比特龙可在降低严重 AE 风险的同时，提高 PFS 和 OS。
