Abiraterone acetate and apalutamide added to androgen deprivation therapy provides the largest overall survival (OS) benefit with low risk for serious adverse events (AEs), according to a comparative-effectiveness analysis of 6 treatments for mestatatic castration-sensitive prostate cancer (JAMA Oncol. 2021;e206973. doi:10.1001/jamaoncol.2020.6973).
“Multiple systemic treatments are available for metastatic castration-sensitive prostate cancer, with unclear comparative effectiveness and safety and widely varied costs,” wrote Lin Wang, MD, MSc, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (Baltimore, MD) and colleagues.
This study aimed to compare the effectiveness and safety of 6 systemic treatments for this patient population, determined in randomized clinical trials.
Dr Wang and colleagues collected data from eligible studies using bibliographic databases, regulatory documents, and trial registries. Studies evaluating the addition of docetaxel, abiraterone acetate, apalutamide, or enzalutamide to ADT for metastatic castration-sensitive prostate cancer were included.
A total of 6 treatments from 7 trials including 7,287 patients were identified: abiraterone acetate, apalutamide, docetaxel, enzalutamide, standard nonsteroidal antiandrogen, and placebo/no treatment.
Treatments associated with improved OS when added to ADT included abiraterone acetate (hazard ratio [HR], 0.61); apalutamide (HR, 0.67); and docetaxel (HR, 0.79). Treatments associated with improved radiographic progression-free survival when added to ADT included enzalutamide (HR, 0.39); apalutamide (HR, 0.48); abiraterone acetate (HR, 0.51); and docetaxel (HR, 0.67).
Docetaxel significantly increased serious AEs and abiraterone acetate slightly increased serious AEs. No other treatment were associated with an increase in serious AEs.
“In this network meta-analysis, as add-on treatments to ADT, abiraterone acetate and apalutamide may provide the largest [OS] benefits with relatively low [serious] AE risks,” Dr Wang and colleagues concluded.—Marta Rybczynski
