Androgen-deprivation therapy plus chemotherapy in metastatic hormone-sensitive prostate cancer. A systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE - To assess the efficacy and toxicity of androgen-deprivation therapy (ADT) plus chemotherapy in patients with hormone-sensitive metastatic prostate cancer.

METHODS - Randomized clinical trials were identified after systematic searching of databases and conference proceedings.

A random-effect model was used to determine the pooled hazard ratio (HR) for the efficacy outcomes-overall survival (OS), biochemical progression-free survival (PFS), and clinical PFS, according to the inverse-variance method. Heterogeneity was measured using the Q and I(2) statistics. A narrative review was done to explore the major adverse drug reactions reported for each trial.

RESULTS - After systematic searching, we included 6 trials (n = 2,675) in this meta-analysis. Estramustine-based chemotherapy plus ADT was not associated with improved OS (HR = 0.64; 95% CI: 0.22-1.89; P = 0.42). In contrast, docetaxel plus ADT was associated with improved OS (HR = 0.75; 95% CI: 0.61-0.91; P = 0.004) and clinical PFS (HR = 0.64; 95% CI: 0.57-0.72; P<0.00001). There was no significant heterogeneity detected among trials. Regarding adverse drug reactions grade 3 or higher, neutropenia was the most frequent side effect reported in a range from 12% to 32%.

CONCLUSIONS - The addition of docetaxel-based chemotherapy to ADT improves OS and clinical PFS in hormone-sensitive metastatic prostate cancer.

Urologic oncology. 2016 Apr 01 [Epub ahead of print]

Allan Ramos-Esquivel, Cristina Fernández, Zenén Zeledón

Departamento de Oncología Médica, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica. Departamento de Farmacia, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica., Departamento de Oncología Médica, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica.