Abstract 12240: A Systematic Review and Network Meta-Analysis of Metastatic Hormone-Sensitive Prostate Cancer Therapy Cardiotoxicity

Abstract

Introduction: The European Association of Urology (EAU) guidelines consider efficacy and safety when recommending metastatic hormone sensitive prostate cancer (mHSPC) therapies but do not account for cardiotoxicity. For patients with low tumor burden ineligible for docetaxel, first-line therapies include androgen deprivation therapy (ADT) plus either apalutamide, enzalutamide, or abiraterone with prednisone. Hypothesis: We expect differences among first-line therapies for the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias. Methods: We searched Ovid Medline, Elsevier Embase, and the Cochrane Library for randomized clinical trials (RCTs) from inception until August 2022. Studies reporting at least one first-line therapy and cardiotoxicity domain were included. Network meta-analysis with a frequentist fixed-effect model was performed to estimate risk ratio (RR) and 95% confidence intervals (CI). Results: For heart failure and arrhythmias, 3 studies with 3376 patients were found with a similar placebo population treated with ADT alone (Figure 1). Four studies with 4526 patients were found assessing hypertension and vascular toxicity. Median follow-up times of studies ranged from 22.75 to 41.00 months. There were no statistically significant differences in heart failure, vascular toxicity, or arrhythmias. However, hypertension was significantly lower in patients treated with ADT plus apalutamide compared to ADT plus abiraterone with prednisone (RR 0.69, 95% CI 0.49 to 0.95). No studies reporting myocarditis were found. Conclusions: Apart from hypertension, no major differences in cardiotoxicity were found among mHSPC first line treatments. Therefore, when selecting therapy, clinicians can prioritize treatment efficacy over concerns regarding cardiotoxicity as long as blood pressure is appropriately controlled.