Song P, et al. - The efficacy and safety of docetaxel, cabazitaxel, docetaxel + estramustine, and mitoxantrone in the management of castration-resistant prostate cancer (CRPC) was compared in this analysis. Findings revealed that cabazitaxel + prednisone (CP) was comparable with docetaxel + prednisone (DP) in survival benefit, clinical improvement, as well as safety outcomes. It was observed that docetaxel + estramustine + prednisone (DEP) was correlated with less survival benefit, similar clinical improvement and more adverse events (AEs) than DP or CP. Data revealed that MP had the lowest survival and clinical benefit, but excellent safety for CRPC subjects. According to the network and ranking results, CP appeared to be the optimal choice among these chemotherapy agents.

Methods

• Researchers searched electronic databases comprising PubMed, Cochrance Library and Embase for studies published from when the databases were established to January 1, 2018.
• After that, randomized controlled trials (RCTs) that compared DP, CP, DEP, and MP for CRPC treatment were identified.
• With software R 3.3.2, the network meta-analysis was conducted.
• The main outcomes, including the overall survival (OS), progression-free survival (PFS), prostate-specific antigen (PSA) response, tumor response, and severe adverse events (AEs) were analyzed.
• For each of the outcomes that were performed, ranking of the chemotherapeutic agents was based on probabilities of interventions.
• By node splitting, the consistency of direct and indirect evidence was evaluated.

Results

• Researchers analyzed 10 RCTs with 3590 subjects.
• The network meta-analysis results showed that CP significantly increased OS, PFS, PSA response, tumor response, and severe AEs compared to MP.
• It was noted that DP showed comparable results with CP except for tumor response, where it showed slight inferiority.
• Findings revealed that DEP was related to clearly improved outcomes in PFS, PSA response and tumor response compared to those of MP, but this was not the case for OS benefit and severe AEs.
• Researchers did not find significant difference in DP, CP and DEP except for severe AEs.
• They discovered that MP was less effective in survival and clinical benefit, but much safer than other chemotherapy agents.
• The probabilities of rank plots demonstrated that CP ranked first in OS and tumor response, DEP ranked first in PFS time and PSA response, MP was the best treatment for safety.