Systemic Therapy for Metastatic Hormone-Sensitive Prostate Cancer: A Randomized Controlled Trial-Based Network Meta-Analysis

Objective. To compare the effects of different treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC) using a network meta-analysis. Methods. English databases (PubMed, Embase, and medRxiv) Chinese (Wanfang CNKI) were searched randomized controlled trials (RCTs) on mHSPC from inception to June 1, 2021. The overall survival (OS) failure-free (FFS) reported by included studies extracted each study Moreover, priority ranks methods determined. Results. A total 18 RCTs with 14,682 patients in this study. Androgen-deprivation therapy (ADT) + apalutamide (APA) showed highest probability improving OS (96.2%) FFS (68.0%). In addition, stratified into ten subgroups as follows: low/high tumor burden (CHAARTED criteria); Gleason score ≤7/≥8; Eastern Cooperative Oncology Group (ECOG) = 0/≥1; with/without prechemotherapy; cooperative concomitant radiotherapy. For improvement OS, leading treatments (1) ADT enzalutamide (ENZA) (64.1%)/ADT abiraterone acetate prednisone (AAP) (54.3%); (2) ENZA (41.9%)/ADT APA (39.2%); (3) (39.2%)/ADT (32.1%); (4) radiotherapy (51%)/ADT (76.7%); (5) AAP (60%). Conclusion. Three endocrine drugs, abiraterone, enzalutamide, APA, exhibited best all subgroups; however, had most prominent effects. Therefore, should be applied common HSPC based objective clinical conditions. Trial Registration. This meta-analysis has been registered PROSPERO website (Trial number: https://www.crd.york.ac.uk/prospero/CRD42020221062).