(UroToday.com) The 2024 European Association of Urology (EAU) annual meeting featured a session on metastatic prostate cancer, and a presentation by Dr. Akihiro Matsukawa discussing the impact of disease volume on the survival efficacy of triplet therapy for metastatic hormone-sensitive prostate cancer (mHSPC). Triplet therapy, androgen receptor signaling inhibitors plus docetaxel plus ADT, is a novel guideline-recommended treatment for mHSPC. However, the optimal selection of the patient most likely to benefit from triplet therapy remains unclear. The aim of this study presented at EAU 2024 was to assess the oncologic benefit of triplet therapy in mHSPC patients stratified by disease volume.
Dr. Matsukawa and colleagues performed a systematic review, meta-analysis, and network meta-analysis to assess the oncologic benefit of triplet therapy in mHSPC patients stratified by disease volume and compare them with doublet treatment regimens. Three databases and meeting abstracts were queried in March 2023 for randomized controlled trials (RCTs) evaluating patients treated with systemic therapy for mHSPC stratified by disease volume. The primary objective was to assess overall survival.
Overall, eight RCTs, involving 6,969 patients were included for meta-analyses and network meta-analyses. Triplet therapy outperformed docetaxel plus ADT in terms of overall survival in both patients with high- (pooled HR: 0.73, 95% CI: 0.64-0.84) and low-volume mHSPC (pooled HR: 0.71, 95% CI: 0.52-0.97). There was no statistically significant difference in overall survival between androgen receptor signaling inhibitors and docetaxel when added to ADT in both with low- versus high-volume disease (p = 0.9). Analysis of treatment rankings in the network meta-analysis showed that darolutamide plus docetaxel plus ADT (90%) had the highest likelihood of improved overall survival in patients with high-volume disease, while enzalutamide plus ADT (84%) had the highest in with low-volume disease:
Dr. Matsukawa concluded this presentation by discussing the impact of disease volume on the survival efficacy of triplet therapy for mHSPC with the following conclusions:
- Triplet therapy improves overall survival in mHSPC patients compared to docetaxel-based doublet therapy, irrespective of disease volume
- However, based on treatment ranking, triplet therapy should preferably be considered for patients with high-volume mHSPC while those with low-volume are likely to be adequately treated with androgen receptor signaling inhibitors + ADT
Presented by: Akihiro Matsukawa, MD, Medical University of Vienna, Vienna, Austria
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 European Association of Urology (EAU) annual congress, Paris, France, April 5th – April 8th, 2024