Comparison of Systemic Treatments for Metastatic Castration-Resistant Prostate Cancer After Docetaxel Failure: A Systematic Review and Network Meta-analysis.
Comparison of Systemic Treatments for Metastatic Castration-Resistant Prostate Cancer After Docetaxel Failure: A Systematic Review and Network Meta-analysis.
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多西紫杉醇失败后转移性去势抵抗性前列腺癌的系统治疗比较：系统评价和网络荟萃分析
DOI：
10.3389/fphar.2021.789319
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发表时间：
2021
影响因子：
5.6
通讯作者：
Sun G
中科院分区：
文献类型：
--
作者：
Chen J;Zhang Y;Zhang X;Zhao J;Ni Y;Zhu S;He B;Dai J;Wang Z;Wang Z;Liang J;Zhu X;Shen P;Zeng H;Sun G
背景：由于缺乏头对头试验，转移性去势抵抗性前列腺癌（mCRPC）患者在多西他赛失败后的最佳治疗尚不清楚。本研究旨在比较多西他赛治疗进展患者的全身治疗的疗效和安全性，以帮助临床决策。方法：检索自成立至2021年6月15日的MEDLINE、EMBASE和Cochrane Library数据库。关注的结局包括总生存期（OS）、生化无进展生存期（bPFS）和严重不良事件（SAEs）。采用Cochrane偏倚风险工具评估研究质量。通过贝叶斯网络meta分析对相互竞争的治疗进行间接比较。结果：5项试验共3862例患者，比较了4种治疗方法（阿比特龙、恩杂鲁胺、卡巴他赛和镭-223）。与最佳支持治疗相比，所有四种治疗均与改善的OS和bPFS相关。其中，恩杂鲁胺（HR = 0.58, 95%可信区间[Crl]: 0.49-0.69）最有可能在OS方面排名第一，其次是卡巴他赛（HR = 0.70, 95% Crl: 0.59-0.83）、223 （HR = 0.71, 95% Crl: 0.56-0.90）和阿比特龙（HR = 0.73, 95% Crl: 0.63-0.84）。同样，恩杂鲁胺（HR = 0.25, 95% Crl: 0.20 ~ 0.31）对bPFS的改善效果最大，其次是阿比特龙（HR = 0.60, 95% Crl: 0.51 ~ 0.71）和卡巴他赛（HR = 0.75, 95% Crl: 0.63 ~ 0.89）。安全性方面，从最安全到最不安全依次为：放射-223 （OR = 0.58, 95% Crl: 0.20-1.68）、恩杂鲁胺（OR = 0.80, 95% Crl: 0.28-2.29）、阿比特龙（OR = 0.94, 95% Crl: 0.39-2.27）和卡巴他赛（OR = 2.50, 95% Crl: 0.84-7.44）。结论：对于多西他赛后进展的mCRPC患者，恩杂鲁胺可能提供最显著的生存获益和令人满意的安全性。卡巴他赛在多西他赛后的情况下是有效的，但与SAEs的高风险相关。虽然网络荟萃分析提供了间接比较和排序概率，但应谨慎对待结果，因为它不能取代随机的直接比较。注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020223040，编号CRD42020223040。
Background: Lacking head-to-head trial, the optimal treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel failure is unclear. This study is to compare the efficacy and safety of systemic treatments in patients who progressed after docetaxel to aid clinical decision-making. Methods: Databases including MEDLINE, EMBASE, and the Cochrane Library were searched from inception to June 15th, 2021. The outcomes of interest include overall survival (OS), biochemical progression-free survival (bPFS), and serious adverse events (SAEs). The Cochrane risk of bias tools were used to assess study quality. Indirect comparisons of competing treatments were performed via Bayesian network meta-analysis. Results: Five trials with 3,862 patients comparing four treatments (abiraterone, enzalutamide, cabazitaxel, and radium-223) were identified. All the four treatments were associated with improved OS and bPFS relative to best supportive care. Among them, enzalutamide (hazard ratio [HR] = 0.58, 95% credible interval [Crl]: 0.49–0.69) had the highest probability of ranking first in terms of OS, followed by cabazitaxel (HR = 0.70, 95% Crl: 0.59–0.83), radium-223 (HR = 0.71, 95% Crl: 0.56–0.90) and abiraterone (HR = 0.73, 95% Crl: 0.63–0.84). Similarly, enzalutamide (HR = 0.25, 95% Crl: 0.20–0.31) showed the greatest improvement of bPFS, followed by abiraterone (HR = 0.60, 95% Crl: 0.51–0.71) and cabazitaxel (HR = 0.75, 95% Crl: 0.63–0.89). In terms of safety, treatments ranked from the safest to the least safe were radium-223 (OR = 0.58, 95% Crl: 0.20–1.68), enzalutamide (OR = 0.80, 95% Crl: 0.28–2.29), abiraterone (OR = 0.94, 95% Crl: 0.39–2.27) and cabazitaxel (OR = 2.50, 95% Crl: 0.84–7.44). Conclusion: For patients with mCRPC who progressed after docetaxel, enzalutamide may offer the most significant survival benefits and satisfying safety. Cabazitaxel is effective in post-docetaxel settings but associated with a high risk of SAEs. Although network meta-analysis provides indirect comparisons and ranking probabilities, the results should be treated with caution as it cannot replace randomized direct comparison. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020223040, identifier CRD42020223040.
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影响因子：
28.4
作者：
Scher HI;Graf RP;Schreiber NA;Jayaram A;Winquist E;McLaughlin B;Lu D;Fleisher M;Orr S;Lowes L;Anderson A;Wang Y;Dittamore R;Allan AL;Attard G;Heller G
通讯作者：
Heller G
影响因子：
158.5
作者：
Parker, C.;Nilsson, S.;Sartor, O.
通讯作者：
Sartor, O.
影响因子：
51.1
作者：
Ryan, Charles J.;Smith, Matthew R.;Rathkopf, Dana E.
通讯作者：
Rathkopf, Dana E.
影响因子：
158.5
作者：
Scher, Howard I.;Fizazi, Karim;de Bono, Johann S.
通讯作者：
de Bono, Johann S.
影响因子：
158.5
作者：
de Wit, Ronald;de Bono, Johann;Castellano, Daniel
通讯作者：
Castellano, Daniel