大体积转移性激素敏感前列腺癌的系统治疗：网络荟萃分析。
Systemic therapies for high-volume metastatic hormone-sensitive prostate cancer: a network meta-analysis.
机构信息
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
出版信息
Acta Oncol. 2023 Sep;62(9):1083-1090. doi: 10.1080/0284186X.2023.2241985. Epub 2023 Aug 7.
BACKGROUND
We compared the effectiveness of currently available systemic therapies for high-volume metastatic hormone-sensitive prostate cancer (mHSPC) and aimed to establish the optimal treatment regimen.
MATERIAL AND METHODS
We searched multiple databases for randomized controlled trials (RCTs) that evaluated the efficacy of systemic therapy in patients with high-volume mHSPC. Bayesian network meta-analysis was used to indirectly compare overall survival (OS) and progression-free survival (PFS) of various systemic therapies.
RESULTS
Eleven RCTs (6708 participants) finally met the eligibility criteria. Compared with androgen deprivation therapy (ADT) alone, rezvilutamide (REZ) [hazard ratio (HR) = 0.58, 95% confidence interval (CI): 0.44-0.77], abiraterone (ABI) (HR = 0.61, 95% CI: 0.53-0.71), apalutamide (APA) (HR = 0.70, 95% CI: 0.56-0.88), enzalutamide (ENZ) (HR = 0.65, 95% CI: 0.53-0.80), docetaxel (DOC) (HR = 0.72, 95% CI: 0.63-0.84), darolutamide (DAR) + DOC (HR = 0.49, 95% CI: 0.39-0.62), and ABI + DOC (HR = 0.52, 95% CI: 0.38-0.71) significantly improved OS in patients with high-volume mHSPC. Compared with DOC, no advantages were observed for doublet therapies, including REZ, ABI, APA, and ENZ on the basis of ADT, whereas DAR + DOC (HR = 0.68, 95% CI: 0.57-0.82) and ABI + DOC (HR = 0.72, 95% CI: 0.55-0.95) was associated with better OS. The ranking analysis showed that triplet therapy (DAR + DOC + ADT and ABI + DOC + ADT) had the greatest improvement in OS, followed by REZ + ADT. All the regimens showed improved PFS in patients with high-volume mHSPC. Compared with DOC, significant differences were detected for DAR + DOC, ABI + DOC, ENZ + DOC, REZ, and ENZ. According to the ranking analysis, triplet therapy ranked first, followed by ENZ and REZ.
CONCLUSIONS
REZ + ADT were the highest ranked doublet therapy for improvement in OS of patients with high-volume mHSPC, second only to triplet therapy (DAR + DOC + ADT and ABI + DOC + ADT).
背景
我们比较了目前可用于治疗大量转移性去势敏感性前列腺癌（mHSPC）的全身治疗的有效性，并旨在确定最佳治疗方案。
材料和方法
我们在多个数据库中搜索了评估高容量 mHSPC 患者全身治疗疗效的随机对照试验（RCT）。贝叶斯网络荟萃分析用于间接比较各种全身治疗的总生存期（OS）和无进展生存期（PFS）。
结果
最终有 11 项 RCT（6708 名参与者）符合入选标准。与单独去势治疗（ADT）相比，瑞维鲁胺（REZ）[风险比（HR）=0.58，95%置信区间（CI）：0.44-0.77]、阿比特龙（ABI）（HR=0.61，95%CI：0.53-0.71）、阿帕鲁胺（APA）（HR=0.70，95%CI：0.56-0.88）、恩扎鲁胺（ENZ）（HR=0.65，95%CI：0.53-0.80）、多西他赛（DOC）（HR=0.72，95%CI：0.63-0.84）、达罗他胺+DOC（HR=0.49，95%CI：0.39-0.62）和 ABI+DOC（HR=0.52，95%CI：0.38-0.71）均显著改善了大量 mHSPC 患者的 OS。与 DOC 相比，基于 ADT 的 REZ、ABI、APA 和 ENZ 等双联治疗并没有显示出优势，而达罗他胺+DOC（HR=0.68，95%CI：0.57-0.82）和 ABI+DOC（HR=0.72，95%CI：0.55-0.95）与更好的 OS 相关。排名分析表明，三联治疗（DAR+DOC+ADT 和 ABI+DOC+ADT）在 OS 改善方面效果最好，其次是 REZ+ADT。所有方案均改善了大量 mHSPC 患者的 PFS。与 DOC 相比，达罗他胺+DOC、ABI+DOC、ENZ+DOC、REZ 和 ENZ 均有显著差异。根据排名分析，三联治疗排名第一，其次是 ENZ 和 REZ。
结论
REZ+ADT 是改善大量 mHSPC 患者 OS 的最高排名双联治疗，仅次于三联治疗（DAR+DOC+ADT 和 ABI+DOC+ADT）。
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