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Impact of performance status on efficacy of systemic therapy for prostate cancer: a meta-analysis
T. Yanagisawa, T. Kawada, K. Mori, SR. Shim, H. Mostafaei, R. Sari Motlagh, F. Quhal, E. Laukhtina, M. von Deimling, A. Bianchi, M. Majdoub, M. Pallauf, B. Pradere, T. Kimura, SF. Shariat, P. Rajwa
Language English Country England, Great Britain
Document type Meta-Analysis, Systematic Review, Journal Article, Review, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 1999
Medline Complete (EBSCOhost)
from 1999-01-01 to 1 year ago
PubMed
37395151
DOI
10.1111/bju.16106
Knihovny.cz E-resources
- MeSH
- Androgen Antagonists adverse effects MeSH
- Progression-Free Survival MeSH
- Docetaxel therapeutic use MeSH
- Humans MeSH
- Prostatic Neoplasms, Castration-Resistant * drug therapy MeSH
- Prostatic Neoplasms * pathology MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Systematic Review MeSH
OBJECTIVE: To evaluate the efficacy of systemic therapies in patients with worse performance status (PS) treated for high-risk non-metastatic prostate cancer (PCa), metastatic hormone-sensitive PCa (mHSPC), and non-metastatic/metastatic castration-resistant PCa (nmCRPC/mCRPC), as there is sparse pooled data showing the effect of PS on oncological outcomes in patients with PCa. METHODS: Three databases were queried in June 2022 for randomised controlled trials (RCTs) analysing patients with PCa treated with systemic therapy (i.e., adding androgen receptor signalling inhibitor [ARSI] or docetaxel [DOC] to androgen-deprivation therapy [ADT]). We analysed the oncological outcomes of patients with PCa with worse PS, defined as Eastern Cooperative Oncology Group PS ≥ 1, treated with combination therapies and compared these to patients with good PS. The main outcomes of interest were overall survival (OS), metastasis-free survival (MFS), and progression-free survival. RESULTS: Overall, 25 and 18 RCTs were included for systematic review and meta-analyses/network meta-analyses, respectively. In all clinical settings, combination systemic therapies significantly improved OS in patients with worse PS as well as in those with good PS, while the MFS benefit from ARSI in the nmCRPC setting was more pronounced in patients with good PS than in those with worse PS (P = 0.002). Analysis of treatment ranking in patients with mHSPC revealed that triplet therapy had the highest likelihood of improved OS irrespective of PS; specifically, adding darolutamide to DOC + ADT had the highest likelihood of improved OS in patients with worse PS. Analyses were limited by the small proportion of patients with a PS ≥ 1 (19%-28%) and that the number of PS 2 was rarely reported. CONCLUSIONS: Among RCTs, novel systemic therapies seem to benefit the OS of patients with PCa irrespective of PS. Our findings suggest that worse PS should not discourage treatment intensification across all disease stages.
Department of Biomedical Informatics College of Medicine Konyang University Daejeon Korea
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Faculty of Medicine and University Hospital of Cologne Cologne Germany
Department of Urology Hillel Yaffe Medical Center Hadera Israel
Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia
Department of Urology La Croix Du Sud Hospital Quint Fonsegrives France
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata Verona Italy
Department of Urology Weill Cornell Medical College New York NY USA
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
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