奥拉帕利联合阿比特龙治疗转移性去势抵抗性前列腺癌患者的疗效和安全性：一项随机对照试验的系统评价和荟萃分析
Efficacy and safety of olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Luo Zhanyang, Zhu Bukun, Xu Hong, Chen Lixin, Song Xiaoyun, Wang Yu, Wang Rui, Zheng Jinzhou, Qiu Yunhua, Yang Jianfeng, Shi Youyang
机构信息
Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
出版信息
Front Oncol. 2023 Oct 6;13:1265276. doi: 10.3389/fonc.2023.1265276. eCollection 2023.
BACKGROUND
Olaparib has been proven for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This meta-analysis aims to comprehensively evaluate the efficacy and safety of the combination of olaparib and abiraterone in patients with mCRPC.
METHODS
The literature in PubMed, Embase, and Cochrane Library up until April 27, 2023, was systematically searched. In the studies included in this meta-analysis, olaparib combined with abiraterone was compared with abiraterone combined with placebo.
RESULTS
Two randomized controlled trials involving a total of 938 patients were included. Analysis indicated that olaparib combined with abiraterone significantly prolonged radiographic progression-free survival (rPFS: relative risk [RR] 0.66, 95% confidence interval [CI] 0.55-0.79), time to secondary progression or death (PFS2: hazard ratio [HR] 0.72, 95% CI 0.56-0.93), time to first subsequent therapy or death (TFST: HR 0.75, 95% CI 0.63-0.89), time to second subsequent therapy or death (TSST: HR 0.73, 95% CI 0.58-0.93), and confirmed prostate-specific antigen (PSA) response (RR 1.14, 95% CI 1.05-1.24). However, no statistically significant differences were found in the overall survival (OS: HR 0.87 95% CI 0.70-1.09), objective response rate (ORR: RR 0.97, 95% CI 0.70-1.33), and incidence of total adverse events (RR 1.07, 95% CI 0.94-1.22). A notable detail that the combination of olaparib and abiraterone was associated with an increased incidence of high-grade anemia (RR 7.47, 95% CI 1.36-40.88).
CONCLUSION
Olaparib combined with abiraterone is effective for patients with mCRPC. However, combination therapy has treatment-related adverse events compared with monotherapy, and this could be improved in future treatment management.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432287.
背景
奥拉帕利已被证实可用于治疗转移性去势抵抗性前列腺癌（mCRPC）。本荟萃分析旨在全面评估奥拉帕利与阿比特龙联合治疗mCRPC患者的疗效和安全性。
方法
系统检索了截至2023年4月27日PubMed、Embase和Cochrane图书馆中的文献。在本荟萃分析纳入的研究中，将奥拉帕利联合阿比特龙与阿比特龙联合安慰剂进行了比较。
结果
纳入了两项随机对照试验，共938例患者。分析表明，奥拉帕利联合阿比特龙显著延长了影像学无进展生存期（rPFS：相对风险[RR]0.66，95%置信区间[CI]0.55 - 0.79）、至二次进展或死亡时间（PFS2：风险比[HR]0.72，95%CI 0.56 - （此处原文有误，应为0.93））、至首次后续治疗或死亡时间（TFST：HR 0.75，95%CI 0.63 - 0.89）、至第二次后续治疗或死亡时间（TSST：HR 0.73，95%CI 0.58 - 0.93），并证实了前列腺特异性抗原（PSA）反应（RR 1.14，95%CI 1.05 - 1.24）。然而，在总生存期（OS：HR 0.87，95%CI 0.70 - 1.09）、客观缓解率（ORR：RR 0.97，95%CI 0.70 - 1.33）和总不良事件发生率（RR 1.07，95%CI （此处原文有误，应为0.94 - 1.22））方面未发现统计学显著差异。一个值得注意的细节是，奥拉帕利与阿比特龙联合使用与高级别贫血发生率增加相关（RR 7.47，95%CI 1.36 - 40.88）。
结论
奥拉帕利联合阿比特龙对mCRPC患者有效。然而，与单药治疗相比，联合治疗存在与治疗相关的不良事件，这在未来的治疗管理中可以得到改善。
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