Efficacy and safety of treatments for metastatic castration-sensitive prostate cancer: A comprehensive network meta-analysis including final ARANOTE data.
Neal Shore, Alicia K Morgans, Noman Paracha et al.
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In 30 seconds
This network meta-analysis compared efficacy and safety of treatment combinations for metastatic castration-sensitive prostate cancer, incorporating final ARANOTE trial data. Outcomes included progression-free survival (PFS), overall survival (OS), and adverse events. Darolutamide plus docetaxel and ADT ranked highest for both efficacy outcomes, with a PFS hazard ratio of 0.27 (95% CrI: 0.18, 0.39) and an OS hazard ratio of 0.52 (0.43, 0.64). Docetaxel combinations had more grade 3-5 adverse events, while darolutamide plus ADT ranked best across safety outcomes and had efficacy comparable to other doublets.
Key findings
- Darolutamide plus docetaxel and ADT had the strongest PFS result: HR 0.27 (95% CrI: 0.18, 0.39); SUCRA was 0.97.
- For OS, darolutamide plus docetaxel and ADT had the lowest HR, 0.52 (0.43, 0.64), and the highest ranking (SUCRA 0.95).
- Grade 3-5 adverse events were more frequent with docetaxel combinations; abiraterone plus docetaxel and ADT had the highest risk.
- Darolutamide plus ADT ranked best for all safety outcomes and was comparable to ADT monotherapy on safety.
Why it matters
The analysis highlights a trade-off relevant to treatment selection: combinations including docetaxel ranked highest for survival outcomes but were associated with more severe adverse events, whereas darolutamide plus ADT had a more favourable safety ranking. These comparative estimates can help frame discussions of efficacy and tolerability, while recognising that the findings are based on indirect comparisons across trials.
What to keep in mind
Network meta-analysis relies on indirect comparisons across trials; the abstract does not report the number of included studies or patients.