Efficacy and Safety of Combined Androgen Blockade with Antiandrogen for Advanced Prostate Cancer

Abstract

Background Combined androgen blockade (cab) is a promising treatment modality for prostate cancer (pca). In the present meta-analysis, we compared the efficacy and safety of first-line cab using an antiandrogen (aa) with castration monotherapy in patients with advanced pca.Methods PubMed, embase, Cochrane, and Google Scholar were searched for randomized controlled trials (rcts) published through 12 December 2016. Hazard ratios (hrs) with 95% confidence intervals (cis) were determined for primary outcomes: overall survival (os) and progression-free survival (pfs). Subgroup analyses were performed for Western compared with Eastern patients and use of a nonsteroidal aa (nsaa) compared with a steroidal aa (saa).Results Compared with castration monotherapy, cab using an aa was associated with significantly improved os (n = 14; hr: 0.90; 95% ci: 0.84 to 0.97; p = 0.003) and pfs (n = 13; hr: 0.89; 95% ci: 0.80 to 1.00; p = 0.04). No significant difference in os (p = 0.71) and pfs (p = 0.49) was observed between the Western and Eastern patients. Compared with castration monotherapy, cab using a nsaa was associated with significantly improved os (hr: 0.88; 95% ci: 0.82 to 0.95; p = 0.0009) and pfs (hr: 0.85; 95% ci: 0.73 to 0.98; p = 0.007)—a result that was not achieved with cab using a saa. The safety profiles of cab and monotherapy were similar in terms of adverse events, including hot flushes, impotence, and grade 3 or 4 events, with the exception of risk of diarrhea and liver dysfunction or elevation in liver enzymes, which were statistically greater with cab using an aa.Conclusions Compared with castration monotherapy, first-line cab therapy with an aa, especially a nsaa, resulted in significantly improved os and pfs, and had an acceptable safety profile in patients with advanced pca.

MicroRNA‑195‑5p is associated with cell proliferation, migration and invasion in prostate cancer and targets MIB1

“…Prostate cancer (PCa) has become a leading cause of cancer-related mortality among men worldwide (1)(2)(3). In addition, as the population ages, prostate cancer rates are likely to increase (4).…”

A novel germline BRCA2 mutation in a Chinese patient with prostate cancer sensitive to platinum chemotherapy: a case report

“…Androgen deprivation therapy combined with bicalutamide was not routinely recommended for metastatic castration-sensitive PCa in international guidelines. However, this combined treatment was still used in some patients in China, since several retrospective studies and meta-analyses showed that this regimen may bring survival benefits to some patients with advanced PCa [ 15 , 16 ].…”

Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update

“…12 For first-generation antiandrogens, the recommendation for M0 disease is based on evidence from meta-analyses. 26 Compared with castration monotherapy, CAB plus an NSAA was associated with significantly improved OS and PFS.…”

“…Six papers were obtained that reported on combination therapies versus castration 12,[26][27][28][29][30] comprising two metaanalyses, 26,27 two RCTs, 12,30 and two large retrospective studies. 28,29 Two meta-analyses reported on combined androgen blockade versus castration.…”