Efficacy and safety of olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a systematic review and meta-analysis of randomized controlled trials

Zhanyang Luo; Bukun Zhu; Hong Xu; Lixin Chen; Xiaoyun Song; Yu Wang; Rui Wang; Jinzhou Zheng; Yunhua Qiu; Jianfeng Yang; Youyang Shi

doi:10.3389/fonc.2023.1265276

Efficacy and safety of olaparib combined with abiraterone in patients with metastatic castration-resistant prostate cancer: a systematic review and meta-analysis of randomized controlled trials

Front Oncol. 2023 Oct 6:13:1265276. doi: 10.3389/fonc.2023.1265276. eCollection 2023.

Authors

Zhanyang Luo¹, Bukun Zhu¹, Hong Xu², Lixin Chen¹, Xiaoyun Song¹, Yu Wang¹, Rui Wang¹, Jinzhou Zheng¹, Yunhua Qiu¹, Jianfeng Yang¹, Youyang Shi¹

Affiliations

¹ Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
² Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.

Abstract

Background: Olaparib has been proven for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This meta-analysis aims to comprehensively evaluate the efficacy and safety of the combination of olaparib and abiraterone in patients with mCRPC.

Methods: The literature in PubMed, Embase, and Cochrane Library up until April 27, 2023, was systematically searched. In the studies included in this meta-analysis, olaparib combined with abiraterone was compared with abiraterone combined with placebo.

Results: Two randomized controlled trials involving a total of 938 patients were included. Analysis indicated that olaparib combined with abiraterone significantly prolonged radiographic progression-free survival (rPFS: relative risk [RR] 0.66, 95% confidence interval [CI] 0.55-0.79), time to secondary progression or death (PFS2: hazard ratio [HR] 0.72, 95% CI 0.56-0.93), time to first subsequent therapy or death (TFST: HR 0.75, 95% CI 0.63-0.89), time to second subsequent therapy or death (TSST: HR 0.73, 95% CI 0.58-0.93), and confirmed prostate-specific antigen (PSA) response (RR 1.14, 95% CI 1.05-1.24). However, no statistically significant differences were found in the overall survival (OS: HR 0.87 95% CI 0.70-1.09), objective response rate (ORR: RR 0.97, 95% CI 0.70-1.33), and incidence of total adverse events (RR 1.07, 95% CI 0.94-1.22). A notable detail that the combination of olaparib and abiraterone was associated with an increased incidence of high-grade anemia (RR 7.47, 95% CI 1.36-40.88).

Conclusion: Olaparib combined with abiraterone is effective for patients with mCRPC. However, combination therapy has treatment-related adverse events compared with monotherapy, and this could be improved in future treatment management.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432287.

Keywords: abiraterone; efficacy; meta-analysis; metastatic castration-resistant prostate cancer (mCRPC); olaparib; safety.

Publication types

Systematic Review

Grants and funding

The research, authorship, and publication of this article were funded by the Natural Science Foundation of Shanghai, China (grant number: 23ZR1464100), the Science and technology development project of Shanghai University of Traditional Chinese Medicine (grant number: 23KFL070) and the National Natural Science Foundation of China (grant number: 82205114).