Comparing efficacy of first-line treatment of metastatic castration resistant prostate cancer: a network meta-analysis of randomized controlled trials

Yang Liu; Xianzhong Deng; Zhi Wen; Jing Huang; Chongjian Wang; Caixia Chen; Erhao Bao; Jiahao Wang; Xuesong Yang

doi:10.3389/fphar.2023.1290990

Comparing efficacy of first-line treatment of metastatic castration resistant prostate cancer: a network meta-analysis of randomized controlled trials

Front Pharmacol. 2023 Nov 22:14:1290990. doi: 10.3389/fphar.2023.1290990. eCollection 2023.

Authors

Yang Liu^#¹, Xianzhong Deng^#², Zhi Wen¹, Jing Huang¹, Chongjian Wang¹, Caixia Chen¹, Erhao Bao¹, Jiahao Wang¹, Xuesong Yang¹

Affiliations

¹ Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
² Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China.

^# Contributed equally.

Abstract

Background: Metastatic castration-resistant prostate cancer (mCRPC) presents significant treatment selection challenges due to limited therapeutic options. This study aimed to comprehensively assess the efficacy of multiple treatment regimens for mCRPC through a network meta-analysis (NMA) of randomized controlled trials (RCTs). Methods: A systematically comprehensive search for randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Embase, and Web of Science databases. The network meta-analysis was employed to compare the overall survival (OS), progression-free survival (PFS), and radiographic progression-free survival (rPFS) among different interventions at specific time points. This study was prospectively registered with PROSPERO (CRD42023422823). Results: A total of 29 RCTs, involving 12,706 patients and investigating 16 interventions, were included in the analysis. Chempretarget ((capivasertib or cabozantinib) + docetaxel + prednisone)) and PARP (Olaparib or rucaparib) inhibitors emerged as interventions that significantly improved survival outcomes compared to first-line treatment in mCRPC patients. Chempretarget demonstrated superior overall survival starting from the 12th month, while PARP inhibitors showed a clear advantage in progression-free survival within the 3-18 months range. Notably, chempre ((Docetaxel or Cabazitaxel) + prednisone) exhibited favorable performance in radiographic progression-free survival during the 3-18 month period. Conclusion: Our findings underscore the efficacy of chempretarget, PARP inhibitors, and chempre in enhancing survival outcomes for mCRPC patients. Further head-to-head comparisons are warranted to validate these results. These findings carry important implications for treatment decision-making in mCRPC and may guide the development of more effective therapeutic strategies.

Keywords: PARP; castration-resistant prostate cancer; meta-analysis; metastatic; prostate cancer; targeted therapy.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Primary Health Development Research Center of Sichuan Province Program (Project number: SWFZ23-Y-55).