The safety of radium-223 combined with new-generation hormonal agents in bone metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis.
The safety of radium-223 combined with new-generation hormonal agents in bone metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis.
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DOI：
10.4103/aja2022108
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发表时间：
2023
影响因子：
2.9
通讯作者：
Shen PF
中科院分区：
文献类型：
--
作者：
Wang MH;Dai JD;Zhang XM;Zhao JG;Sun GX;Zeng YH;Zeng H;Xu NW;Zeng H;Shen PF
骨转移性去势抵抗性前列腺癌（mCRPC）患者在生存率和生活质量（QoL）方面可能受益于镭-223（223 Ra）联合新一代激素类药物（NHA）。然而，联合治疗的安全性仍不清楚。因此，我们旨在通过审查223 Ra与醋酸阿比特龙加泼尼松（AAP）或Enzalutamide联合治疗的文献进行网络荟萃分析，并评价联合治疗在骨mCRPC患者中的安全性。最终，选择了10项研究（2835例患者），包括4项随机对照试验（RCT）、5项回顾性队列研究和1项单组研究。总体而言，223 Ra +NHA联合治疗组与223 Ra单药治疗组之间的骨折发生率无差异（比值比[OR]：1.46，95%置信区间[CI]：0.91-2.34，P = 0.66），但223 Ra +NHA联合治疗组的发生率223 Ra单药治疗组（OR：2.24，95%CI：1.23 -4.08，P < 0.01）高于NHA单药治疗组（OR：3.22，95%CI：2.24 -4.63，P < 0.01）。然而，在仅涉及RCT的荟萃分析中，223 Ra单药治疗组和NHA单药治疗组之间没有差异（OR：1.14，95%CI：0.22-5.95，P = 0.88），而223 Ra +NHA联合治疗组与NHA单药治疗组之间的差异仍具有显著性（OR：3.22，95% CI：2.24-4.63，P < 0.01）。所有组之间的症状性骨骼事件（SSE）、无SSE生存期（SSE-FS）、所有级别的常见不良事件（AE）和≥ 3级AE未显示任何显著差异。我们的研究结果表明，与223 Ra单药治疗相比，223 Ra与NHA联合治疗在骨mCRPC患者中耐受性良好，尽管接受223 Ra治疗的患者的骨折发生率高于接受NHA单药治疗的患者。需要更多的证据来探索223 Ra联合治疗的安全性和有效性。
Patients with bone metastatic castration-resistant prostate cancer (mCRPC) might benefit from radium-223 (223Ra) combined with new-generation hormonal agents (NHAs) in terms of survival and quality of life (QoL). However, the safety of combination therapies remains unclear. Therefore, we aimed to perform a network meta-analysis by reviewing the literature about the combination of 223Ra with abiraterone acetate plus prednisone (AAP) or enzalutamide and to evaluate the safety of combination therapy in bone mCRPC patients. Ultimately, ten studies (2835 patients) were selected, including four randomized controlled trials (RCTs), five retrospective cohort studies, and one single-arm study. Overall, there was no difference in the incidence of fracture between the 223Ra+NHA combination group and the 223Ra monotherapy group (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.91–2.34, P = 0.66), but the incidences in both the 223Ra+NHA combination group (OR: 3.22, 95% CI: 2.24–4.63, P < 0.01) and the 223Ra monotherapy group (OR: 2.24, 95% CI: 1.23–4.08, P < 0.01) were higher than that in the NHA monotherapy group. However, in the meta-analysis involving only RCTs, there was no difference between the 223Ra monotherapy group and the NHA monotherapy group (OR: 1.14, 95% CI: 0.22–5.95, P = 0.88), while the difference between the 223Ra+NHA combination group and the NHA monotherapy group remained significant (OR: 3.22, 95% CI: 2.24–4.63, P < 0.01). Symptomatic skeletal events (SSEs), SSE-free survival (SSE-FS), all grades of common adverse events (AEs), and ≥grade 3 AEs among all groups did not show any significant difference. Our results indicate that the combination of 223Ra with NHAs was well tolerated in bone mCRPC patients compared to 223Ra monotherapy, even though the incidence of fracture was higher in patients who received 223Ra than that among those who received NHA monotherapy. More evidence is needed to explore the safety and efficiency of 223Ra combination therapies.
影响因子：
7.3
作者：
Petrylak DP;Vaishampayan UN;Patel KR;Higano CS;Albany C;Dawson NA;Mehlhaff BA;Quinn DI;Nordquist LT;Wagner VJ;Siegel J;Trandafir L;Sartor O
通讯作者：
Sartor O
影响因子：
4.8
作者：
McKay RR;Silver R;Bhak RH;Korves C;Cheng M;Appukkuttan S;Simmons SJ;Duh MS;Taplin ME
通讯作者：
Taplin ME