Universidade de São Paulo, São Paulo, SP, Brazil.
Hospital do Servidor Púbico Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2022 Apr 1;20:eRW6339. doi: 10.31744/einstein_journal/2022RW6339. eCollection 2022.
To evaluate whether the addition of statins to the new antiandrogens (enzalutamide or abiraterone) affects overall survival in patients with metastatic castration-resistant prostate cancer.
We searched studies in English language including the keywords statins, overall survival, and metastatic castration-resistant prostate cancer, at PubMed® (MEDLINE®), Embase and Cochrane databases.
A total of 195 articles were initially identified, but only four met the inclusion criteria and were selected for the meta-analysis. A total of 955 patients, 632 on the new antiandrogens only group, and 323 on the new antiandrogens + statins group, were analyzed. In all four studies the combination therapy (new antiandrogens + statin) was well tolerated, regardless of which new antiandrogens were used. Neither the type of statin nor the doses and duration of use were well specified in the studies. The combination therapy in metastatic castration-resistant prostate cancer was associated with an overall survival improvement, and a 46% reduction in death (hazard ratio of 0.54; 95%CI 0.34-0.87; p<0.01) in multivariate analysis.
There seems to be a clinical benefit with the association of statins to the new antiandrogens in patients with metastatic castration-resistant prostate cancer, suggesting longer overall survival with no important collateral effect. However, due to fragility of the studies available in the literature, we are not yet capable of recommending this combination of drugs in the clinical practice. Further randomized prospective studies are warranted to confirm these beneficial outcomes.
评估在转移性去势抵抗性前列腺癌患者中，将他汀类药物与新型抗雄激素药物（恩扎鲁胺或阿比特龙）联合使用是否会影响总生存期。
我们在 PubMed®（MEDLINE®）、Embase 和 Cochrane 数据库中使用关键词“他汀类药物”、“总生存期”和“转移性去势抵抗性前列腺癌”搜索了英文文献。
最初共确定了 195 篇文章，但只有 4 篇符合纳入标准并被选入荟萃分析。共有 955 名患者纳入分析，其中 632 名患者仅接受新型抗雄激素治疗，323 名患者接受新型抗雄激素+他汀类药物治疗。在所有四项研究中，联合治疗（新型抗雄激素+他汀类药物）均耐受良好，无论使用哪种新型抗雄激素药物。在研究中，他汀类药物的类型、剂量和使用时间均未得到很好的说明。在转移性去势抵抗性前列腺癌中，联合治疗与总生存期的改善相关，死亡风险降低 46%（风险比为 0.54；95%CI 0.34-0.87；p<0.01）。
在转移性去势抵抗性前列腺癌患者中，他汀类药物与新型抗雄激素药物联合使用似乎具有临床获益，提示总生存期延长，且无重要的不良反应。然而，由于现有文献中的研究存在脆弱性，我们目前还不能在临床实践中推荐这种联合用药。需要进一步进行随机前瞻性研究来证实这些有益的结果。
