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Comparison of Oncologic Outcomes Between Two Alternative Sequences with Abiraterone Acetate and Enzalutamide in Patients with Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis

 Doo Yong Chung  ;  Dong Hyuk Kang  ;  Jong Won Kim  ;  Do Kyung Kim  ;  Joo Yong Lee  ;  Chang Hee Hong  ;  Kang Su Cho 
 CANCERS, Vol.12(1) : E8, 2019 
Journal Title
Issue Date
abiraterone acetate ; enzalutamide ; meta-analysis ; metastatic castration-resistant prostate cancer ; sequential therapy ; systemic review
Sequential treatment of androgen receptor axis targeted agents (ARAT), abiraterone acetate (ABI) and enzalutamide (ENZA), in metastatic castration-resistant prostate cancer (mCRPC) demonstrated some positive effects, but cross-resistances between ABI and ENZA that reduce activity have been suggested. Therefore, we conducted a meta-analysis to compare oncologic outcomes between the treatment sequences of ABI-ENZA and ENZA-ABI in patients with mCRPC. The primary endpoint was a combined progression-free survival (PFS), and the secondary endpoint was overall survival (OS). A total of five trials on 553 patients were included in this study. Each of the included studies was retrospective. In two studies including both chemo-naïve and post-chemotherapy mCRPC patients, for ABI-ENZA compared with ENZA-ABI, pooled hazard ratios (HRs) for PFS and OS were 0.37 (p < 0.0001; 95% confidence intervals (CIs), 0.23-0.60) and 0.64 (p = 0.10; 95% CIs, 0.37-1.10), respectively. In three studies with chemo-naïve mCRPC patients only, for ABI-ENZA compared with ENZA-ABI, pooled HRs for PFS and OS were 0.57 (p = 0.02; 95% CIs, 0.35-0.92) and 0.86 (p = 0.39; 95% CIs, 0.61-1.21), respectively. The current meta-analysis revealed that ABI-ENZA had a significantly more favorable oncological outcome, but the level of evidence was low. Therefore, large-scale randomized trials may be needed.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Won(김종원) ORCID logo https://orcid.org/0000-0002-0449-228X
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Chung, Doo Yong(정두용)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Hong, Chang Hee(홍창희) ORCID logo https://orcid.org/0000-0002-0946-7702
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