First-Line Systemic Treatments of Metastatic Hormone-Sensitive Prostate Cancer: Updated Systematic Review and Network Meta-Analysis.
Keiichiro Miyajima, Marcin Miszczyk, Akihiro Matsukawa et al.
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In 30 seconds
This systematic review and network meta-analysis evaluated the efficacy and safety of first-line systemic combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC) across 23 trials involving 18,689 patients. The analysis found that while docetaxel + ARPI + ADT improved overall survival in high-volume disease (HR 0.76), no triplet regimen showed a statistically significant overall survival benefit in the all-comer population.
Key findings
- Docetaxel + ARPI + ADT improved overall survival in high-volume mHSPC (HR 0.76, 95% CI 0.61-0.95).
- Docetaxel + ARPI + ADT and PARPi + ARPI + ADT showed clinically relevant progression-free survival improvements compared to ARPI + ADT.
- No triplet regimen demonstrated a statistically significant overall survival benefit over ARPI + ADT in the all-comer population.
- Safety estimates for triplet regimens were imprecise, indicating potential increases in toxicity.
Why it matters
Understanding the efficacy and safety of combination therapies for mHSPC is crucial for clinicians to make informed treatment decisions, particularly in selecting appropriate regimens for patients with high-volume disease versus those with lower disease burden.
What to keep in mind
The evidence certainty was downgraded due to risk of bias from open-label designs and imprecision, especially for PARPi-based regimens.