Pui San Tan1, Pedro Aguiar2, Benjamin Haaland3, Gilberto Lopes4. 1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. puisan.tan@gmail.com. 2. Clinical Oncology Sector, Faculdade de Medicina do ABC, Santo André, Brazil. 3. Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 4. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
Abstract
BACKGROUND: Patients with metastatic prostate cancer have poor prognosis. In this study, we compared the addition of abiraterone, docetaxel, bisphosphonate, celecoxib or combinations to standard ADT vs. ADT alone for patients with mHSPC in terms of overall survival (OS), failure-free survival (FFS), and adverse events. METHODS: We searched PubMed and performed a network meta-analysis to generate probabilistic inferences and provide efficacy rankings in terms of posterior hazard ratios with 95% credible intervals (CrI), surface under the cumulative ranking curve (SUCRA), probability better than competing treatments, and probability best. RESULTS: Seven trials were included (LATITUTE, STAMPEDE, CHAARTED, GETUG-AFU15, ZAPCA, CALGB 90202, and MRC PR05). Compared to ADT alone, evidence suggests abiraterone + ADT (OS HR: 0.60; 95% CrI: 0.50-0.71, FFS HR: 0.31; 95% CrI: 0.25-0.38) could be superior in terms of OS and FFS compared to docetaxel + ADT (OS 0.74; 95% CrI: 0.63-0.86, FFS 0.62; 95% CrI: 0.53-0.74), bisphosphonate + ADT (OS: 0.87; 95% CrI: 0.75-1.00, FFS 0.87; 95% CrI: 0.75-1.00), celecoxib + ADT (OS: 0.91; 95% CrI: 0.71-1.17, FFS: 0.86; 95% CrI: 0.68-1.08), or triple combinations. Abiraterone + ADT suggests improved survival with 97% certainty for a 19% reduction in risk of death compared to docetaxel + ADT (HR: 0.81; 95% CrI: 0.66-1.00). DISCUSSION: Addition of abiraterone to standard ADT may possibly outperform the addition of docetaxel, bisphosphonates, celecoxib, or combinations to standard ADT in terms of OS and FFS.
BACKGROUND:Patients with metastatic prostate cancer have poor prognosis. In this study, we compared the addition of abiraterone, docetaxel, bisphosphonate, celecoxib or combinations to standard ADT vs. ADT alone for patients with mHSPC in terms of overall survival (OS), failure-free survival (FFS), and adverse events. METHODS: We searched PubMed and performed a network meta-analysis to generate probabilistic inferences and provide efficacy rankings in terms of posterior hazard ratios with 95% credible intervals (CrI), surface under the cumulative ranking curve (SUCRA), probability better than competing treatments, and probability best. RESULTS: Seven trials were included (LATITUTE, STAMPEDE, CHAARTED, GETUG-AFU15, ZAPCA, CALGB 90202, and MRC PR05). Compared to ADT alone, evidence suggests abiraterone + ADT (OS HR: 0.60; 95% CrI: 0.50-0.71, FFS HR: 0.31; 95% CrI: 0.25-0.38) could be superior in terms of OS and FFS compared to docetaxel + ADT (OS 0.74; 95% CrI: 0.63-0.86, FFS 0.62; 95% CrI: 0.53-0.74), bisphosphonate + ADT (OS: 0.87; 95% CrI: 0.75-1.00, FFS 0.87; 95% CrI: 0.75-1.00), celecoxib + ADT (OS: 0.91; 95% CrI: 0.71-1.17, FFS: 0.86; 95% CrI: 0.68-1.08), or triple combinations. Abiraterone + ADT suggests improved survival with 97% certainty for a 19% reduction in risk of death compared to docetaxel + ADT (HR: 0.81; 95% CrI: 0.66-1.00). DISCUSSION: Addition of abiraterone to standard ADT may possibly outperform the addition of docetaxel, bisphosphonates, celecoxib, or combinations to standard ADT in terms of OS and FFS.
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