Department of Urology, University of Florida, Jacksonville, FL.
Department of Biostatistics, University of Florida, Jacksonville, FL.
Urol Oncol. 2020 Nov;38(11):826-834. doi: 10.1016/j.urolonc.2020.03.022. Epub 2020 Jun 28.
Studies using apalutamide, enzalutamide, or darolutamide have shown improved metastasis free survival (MFS) rates, leaving clinicians with a dilemma of choosing one over the other, for nonmetastatic castration recurrent prostate cancer (nmCRPC). We performed a network meta-analysis to provide an indirect comparison of oncologic outcomes and adverse events (AEs) of these medications.
We searched PubMed, MEDLINE, and SCOPUS databases, for studies reporting apalutamide, enzalutamide, or darolutamide until January 25, 2020. Results were input into an EndNote library, and data were extracted into a predefined template. Progression free survival (PFS) was defined as radiologic progression or death. Network meta-analysis was done using R and meta-analysis was performed with RevMan v. 5. Surface under the cumulative ranking (SUCRA) value was used to provide rank probabilities.
We found 3 studies reporting results for apalutamide, enzalutamide, and darolutamide. MFS was significantly lower in patients receiving darolutamide compared to both apalutamide (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.55-0.97) and enzalutamide (HR: 0.71, 95% CI: 0.54-0.93). MFS was similar for enzalutamide and apalutamide (HR: 0.97, 95% CI: 0.73-1.28). In PFS, apalutamide showed a slightly higher rate compared to darolutamide (HR: 0.76, 95% CI: 0.59-0.99). There was no difference in overall survival (OS) between any of the medications. There was no statistically significant difference in AEs profile of the 3 medications. However, darolutamide had the highest SUCRA value and probability of being the most preferred medication based on AEs profile.
Enzalutamide and apalutamide had similar and higher MFS rate in indirect comparison with darolutamide. In cases where AEs are concerning, darolutamide might be the preferred agent.
使用阿帕鲁胺、恩扎卢胺或达罗他胺的研究显示，无转移生存（MFS）率有所提高，这让临床医生在治疗非转移性去势抵抗性前列腺癌（nmCRPC）时陷入了选择哪种药物的困境。我们进行了一项网络荟萃分析，以提供这些药物在肿瘤学结果和不良事件（AE）方面的间接比较。
我们在 PubMed、MEDLINE 和 SCOPUS 数据库中搜索了截至 2020 年 1 月 25 日报告阿帕鲁胺、恩扎卢胺或达罗他胺的研究。结果输入到 EndNote 库中，并将数据提取到预定义的模板中。无进展生存期（PFS）定义为影像学进展或死亡。使用 R 进行网络荟萃分析，使用 RevMan v.5 进行荟萃分析。累积排序曲面下面积（SUCRA）值用于提供等级概率。
我们发现有 3 项研究报告了阿帕鲁胺、恩扎卢胺和达罗他胺的结果。与阿帕鲁胺（危险比[HR]：0.73，95%置信区间[CI]：0.55-0.97）和恩扎卢胺（HR：0.71，95% CI：0.54-0.93）相比，接受达罗他胺治疗的患者 MFS 显著降低。恩扎卢胺和阿帕鲁胺的 MFS 相似（HR：0.97，95% CI：0.73-1.28）。在 PFS 方面，阿帕鲁胺的比率略高于达罗他胺（HR：0.76，95% CI：0.59-0.99）。在任何一种药物中，总生存（OS）均无差异。这 3 种药物的 AE 谱没有统计学上的显著差异。然而，达罗他胺的 SUCRA 值最高，根据 AE 谱，其成为最受欢迎药物的概率最高。
在与达罗他胺的间接比较中，恩扎卢胺和阿帕鲁胺的 MFS 率相似且更高。在关注 AE 的情况下，达罗他胺可能是首选药物。
