(UroToday.com) The 2025 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between February 13th and 15th 2025, was host to the Poster Session A: Prostate Cancer. Dr. Morris presented Abstract 267: Population-adjusted network meta-analyses (NMA) to evaluate the efficacy of treatment alternatives for metastatic hormone-sensitive prostate cancer (mHSPC).
Dr. Shore began his presentation by highlighting that existing network meta-analyses (NMA) in metastatic hormone-sensitive prostate cancer (mHSPC) typically compare treatments under the assumption of homogeneity in treatment effect modifiers across study populations. However, emerging evidence suggests that these effects vary in mHSPC. This study employs advanced methodologies, including multilevel network meta-regression (ML-NMR) and network meta-interpolation (NMI), to account for population differences and generate adjusted relative effect estimates for an ARASENS-like target population.
The investigators conducted a systematic literature review to identify studies for the network meta-analysis on overall survival in mHSPC. They applied multilevel network meta-regression to adjust for imbalances in treatment effect modifiers by integrating individual patient data regression from the ARASENS trial across the covariate distributions of comparator studies. Individual patient data were reconstructed from Kaplan-Meier curves for aggregate data studies, incorporating key covariates such as age, performance status, Gleason score, and disease volume. Using the same set of variables, network meta-interpolation was employed to analyze subgroup data from comparator studies based on reported hazard ratios.
A total of twelve studies were identified for inclusion in this analysis. The multilevel network meta-regression demonstrated a significant benefit for the combination of androgen deprivation therapy, docetaxel, and darolutamide compared to androgen deprivation therapy with enzalutamide, apalutamide, abiraterone, and the combination of androgen deprivation therapy, docetaxel, and abiraterone in the ARASENS-like population.
However, the network meta-interpolation analysis showed that the combination of androgen deprivation therapy, docetaxel, and darolutamide was significantly favored over androgen deprivation therapy with abiraterone when compared to other commonly used alternatives. A key advantage of multilevel network meta-regression over network meta-interpolation is that it only requires baseline characteristics to be reported, rather than subgroup data, which were either poorly reported or not adequately powered to detect statistically significant differences. The network meta-interpolation method was limited by incomplete subgroup data, with full data for effect modifiers available in only eight of the twelve studies.
Dr. Shore concluded his presentation with the following key points:
- Both multilevel network meta-regression and network meta-interpolation analyses support the survival benefit of triplet therapy with androgen deprivation therapy, docetaxel, and darolutamide in mHSPC.
- The findings from multilevel network meta-regression are particularly robust, given the incorporation of more comprehensive covariate data, which reduces uncertainty and strengthens the reliability of the analysis.
Presented by: Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center. Urologist at the Atlantic Urology Clinics in Myrtle Beach, South Carolina.
Written by: Julian Chavarriaga, MD – Urologic Oncologist at Cancer Treatment and Research Center (CTIC) via Society of Urologic Oncology (SUO) Fellow at The University of Toronto. @chavarriagaj on Twitter during the 2025 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Feb 13 – Sat, Feb 15, 2025.