Key clinical point: Abiraterone acetate and apalutamide were associated with significantly improved overall survival and relatively low rates of serious adverse events for castration-resistant prostate cancer.

Major finding: In a meta-analysis of 7 trials comparing 6 treatments for prostate cancer, the treatments with the most significant improvements in overall survival were abiraterone acetate (hazard ratio 0.61), apalutamide (HR 0.67), and docetaxel (HR 0.79).

Study details: The data come from a meta-analysis of 7 randomized clinical trials including 7,287 prostate cancer patients.

Disclosures: The study was supported by the Dyar Memorial Fund and Pharmaceutical Research and Manufacturers of America Foundation 2020 Predoctoral Fellowship in Health Outcomes Research to lead author Dr. Wang, who had no financial conflicts to disclose.

Commentary

“Over the last several years, a number of studies have been reported suggesting that systemic therapy for patients with metastatic castrate-sensitive prostate cancer (mCSPC) may result in clinical benefit. However, these therapies have not been studied head-to-head, so alternative analyses are needed to compare the relative merits of these agents. Wang et al. conducted a meta-analysis of 6 drugs studied in 7 trials to compare the outcomes of overall survival (OS) and radiographic progression-free survival (rPFS). Abiraterone, apalutamide, and docetaxel were associated with improved OS, while enzalutamide, apalutamide, abiraterone, and docetaxel were associated with improved rPFS. Docetaxel had the strongest association with serious adverse events. However, the potential for bias across studies, including varying outcome definitions and follow-up intervals, may affect the analyses somewhat. Such limitations suggest the need for more head-to-head studies to resolve these questions.”

Mark Klein, MD