Cancer Health Services Research, Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Centre for Cancer Research, Melbourne, VIC, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, VIC, Australia; Department of Medical Oncology, Monash Health, VIC, Australia.
Eur Urol Focus. 2021 Jul;7(4):752-763. doi: 10.1016/j.euf.2020.03.003. Epub 2020 Apr 6.
Optimal treatment sequencing of abiraterone and enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) is challenging. Real-world data (RWD) allow a better understanding of health economic implications in the real world.
To determine survival and cost outcomes for two real-world treatment sequences, comparing abiraterone to enzalutamide (AA → ENZ) with enzalutamide to abiraterone (ENZ → AA).
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed in Medline, Embase, and Web of Science.
Seventeen studies met our inclusion criteria. Of studies with survival outcomes, 10 featured AA → ENZ treatment sequences (n = 575), four ENZ → AA sequences (n = 205), and three both sequences. Better survival outcomes were demonstrated in the AA → ENZ cohorts in several studies reporting prostate-specific antigen (PSA) progression-free survival (PSA-PFS), combined PSA-PFS, and PSA decline ≥50%. Three studies showed shorter treatment duration in cohorts receiving second-line enzalutamide compared with abiraterone. Collectively, six RWD costing studies described patients with mCRPC who experienced treatment with enzalutamide (n = 4195), abiraterone (n = 10 372), AA → ENZ (n = 443), and ENZ → AA (n = 91). No study estimated the cost of treatment sequencing of AA → ENZ or ENZ → AA.
No head-to-head studies were found, but we hypothesise that the AA → ENZ sequence may be less costly than ENZ → AA, because time on treatment tends to be longer for a first-line treatment and abiraterone is less costly than enzalutamide. There are indications that PFS of AA → ENZ is superior to that of ENZ → AA, which supports the former sequence as more cost-effective.
Better survival outcomes were reported in several studies where patients with advanced prostate cancer received the abiraterone to enzalutamide sequence compared with the enzalutamide to abiraterone sequence. No study estimated the cost of sequencing either treatment approach.
在未经化疗的转移性去势抵抗性前列腺癌（mCRPC）中，阿比特龙和恩扎鲁胺的最佳治疗顺序是具有挑战性的。真实世界数据（RWD）可以更好地了解实际情况下的健康经济学影响。
确定两种真实世界治疗顺序的生存和成本结果，比较阿比特龙至恩扎鲁胺（AA→ENZ）与恩扎鲁胺至阿比特龙（ENZ→AA）。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行了系统评价。在 Medline、Embase 和 Web of Science 中进行了搜索。
有 17 项研究符合我们的纳入标准。在具有生存结果的研究中，有 10 项研究采用 AA→ENZ 治疗序列（n=575），4 项研究采用 ENZ→AA 序列（n=205），3 项研究同时采用两种序列。几项研究报告了前列腺特异性抗原（PSA）无进展生存期（PSA-PFS）、联合 PSA-PFS 和 PSA 下降≥50%，显示 AA→ENZ 队列的生存结果更好。三项研究表明，与阿比特龙相比，接受二线恩扎鲁胺治疗的队列的治疗持续时间更短。共有六项 RWD 成本研究描述了接受恩扎鲁胺（n=4195）、阿比特龙（n=10372）、AA→ENZ（n=443）和 ENZ→AA（n=91）治疗的 mCRPC 患者。没有研究估计 AA→ENZ 或 ENZ→AA 的治疗顺序成本。
没有发现头对头的研究，但我们假设 AA→ENZ 序列的成本可能低于 ENZ→AA，因为一线治疗的治疗时间往往更长，而且阿比特龙比恩扎鲁胺便宜。有迹象表明，AA→ENZ 的 PFS 优于 ENZ→AA，这支持前者作为更具成本效益的治疗方案。
在几项研究中，接受晚期前列腺癌治疗的患者接受阿比特龙至恩扎鲁胺序贯治疗的生存结果优于恩扎鲁胺至阿比特龙序贯治疗。没有研究估计这两种治疗方法的测序成本。
