Androgen deprivation therapy (ADT) has long been the gold standard for patients with metastatic hormone-sensitive prostate cancer (mHSPC). Clinical trials have demonstrated significant survival benefits when docetaxel (DOC) or abiraterone acetate (AA) and prednisone (P) are added to ADT, necessitating comparison of these combination treatments.
A systematic review of randomised controlled trials (RCTs) of AA-/ADT-/DOC-containing treatment regimens in newly diagnosed patients with high-risk and/or high-volume mHSPC identified three RCTs (LATITUDE, CHAARTED and GETUG-AFU 15). Network meta-analyses (NMAs) using fixed effects Bayesian methods were performed to compare relative benefits of each treatment on overall survival (OS), radiographic progression-free survival (rPFS) and quality of life (QoL) measured by the Brief Pain Inventory, and the Functional Assessment of Cancer Therapy-Prostate questionnaire. One trial, STAMPEDE, was assessed in exploratory OS analyses.
The hazard ratio (HR) for OS ranged from 0.85 to 0.92, with the Bayesian probability of AA + P + ADT being better than DOC + ADT ranging between 72% and 87%. For rPFS, the HR ranged between 0.71 and 0.76 (Bayesian probability range: 93%-97%). Exploratory analyses including STAMPEDE found similar trends. AA + P + ADT also showed improved QoL compared with DOC + ADT for at least 1 year of therapy, with results being more pronounced at 3 months.
Our findings suggest that AA + P + ADT is at least as effective as DOC + ADT in reducing the risk of death in men with mHSPC and better at preventing disease progression and improving QoL. The NMA provides useful insights to clinicians and other decision-makers on the relative efficacy of treatment options for men with mHSPC.
European journal of cancer (Oxford, England : 1990). 2018 Sep 12 [Epub ahead of print]
Susan Feyerabend, Fred Saad, Tracy Li, Tetsuro Ito, Joris Diels, Suzy Van Sanden, Peter De Porre, Julie Roiz, Seye Abogunrin, Maria Koufopoulou, Karim Fizazi
Urologic Oncology, Studienpraxis Urologie, Steinengrabenstr. 17, Nürtingen, 72622, Germany. Electronic address: ., Urologic Oncology, Centre Hospitalier de L'Université de Montréal/CRCHUM, 900 Rue St-Denis, Porte R10-464, Montréal, Québec, H2X 0A9, Canada. Electronic address: ., Global Market Access Oncology, Janssen Global Services, 700 US Highway 202 South Raritan, NJ, 08869, USA. Electronic address: ., Health Economics & Market Access EMEA, Janssen, 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG, UK. Electronic address: ., Health Economics & Market Access EMEA, Janssen, Turnhoutseweg 30, 2340, Beerse, Belgium. Electronic address: ., Health Economics & Market Access EMEA, Janssen, Turnhoutseweg 30, 2340, Beerse, Belgium. Electronic address: ., Clinical Oncology, Janssen Research & Development BE, Antwerpsesteenweg 15, 2340, Beerse, Belgium. Electronic address: ., Modeling & Simulation, Evidera, Metro Building, Sixth Floor, 1 Butterwick, London, W6 8DL, UK. Electronic address: ., Meta Research, Evidera, Metro Building, Sixth Floor, 1 Butterwick, London, W6 8DL, UK. Electronic address: ., Meta Research, Evidera, Metro Building, Sixth Floor, 1 Butterwick, London, W6 8DL, UK. Electronic address: ., Gustave Roussy, University of Paris Sud, 114 Rue Edouard Vaillant, 94800 Villejuif, France. Electronic address: .