Abstract
Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol
Highlights
The majority of men who die from prostate cancer in Europe and North America are non-metastatic at diagnosis.[1,2 3] years of androgen-deprivation therapy (ADT; orchiectomy or gonadotropin-releasing hormone agonists or antagonists) and local radiotherapy are the mainstay of treatment for non-metastatic prostate cancer with high-risk features.[3,4,5,6]
Evidence before this study We used a range of terms, including “non-metastatic prostate cancer and docetaxel or abiraterone or apalutamide or enzalutamide or androgen receptor blockade or androgen deprivation therapy”, to search MEDLINE (Jan 1, 1966, to June 30, 2021), Embase (Jan 1, 1982, to June 30, 2021), and major urology and oncology conference proceedings (Jan 1, 1990 to June 30, 2021) for randomised controlled trials, published in English, of abiraterone, enzalutamide, apalutamide, or docetaxel added to 3-year androgendeprivation therapy (ADT) alone or in combination with local radiotherapy for men with non-metastatic prostate cancer
One conducted in the STAMPEDE platform protocol, the NRG Oncology/RTOG 0521 trial, and the GETUG-12 trial, docetaxel added to ADT prolonged time to relapse but neither metastasis-free survival nor overall survival
Summary
The majority of men who die from prostate cancer in Europe and North America are non-metastatic at diagnosis.[1,2 3] years of androgen-deprivation therapy (ADT; orchiectomy or gonadotropin-releasing hormone agonists or antagonists) and local radiotherapy are the mainstay of treatment for non-metastatic prostate cancer with high-risk features.[3,4,5,6] It is known that combining ADT with docetaxel or second-generation hormone treatment (abiraterone, enzalutamide, or apalutamide)Research in contextEvidence before this study We used a range of terms, including “non-metastatic prostate cancer and docetaxel or abiraterone or apalutamide or enzalutamide or androgen receptor blockade or androgen deprivation therapy”, to search MEDLINE (Jan 1, 1966, to June 30, 2021), Embase (Jan 1, 1982, to June 30, 2021), and major urology and oncology conference proceedings (Jan 1, 1990 to June 30, 2021) for randomised controlled trials, published in English, of abiraterone, enzalutamide, apalutamide, or docetaxel added to 3-year androgendeprivation therapy (ADT) alone or in combination with local radiotherapy for men with non-metastatic prostate cancer. One conducted in the STAMPEDE platform protocol, the NRG Oncology/RTOG 0521 trial, and the GETUG-12 trial, docetaxel added to ADT prolonged time to relapse but neither metastasis-free survival nor overall survival. Another trial in the STAMPEDE platform protocol reported a survival benefit of adding abiraterone to ADT in both metastatic and non-metastatic patients but the latter group had insufficient events for certainty of the treatment benefit. Our analysis identifies more toxicity but no evidence of a difference in treatment effect from combination of enzalutamide and abiraterone compared with abiraterone alone
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