|
|||||
|
|
Impact of performance status on efficacy of systemic therapy for prostate cancer: a meta-analysis |
|
| Authors: | Takafumi Yanagisawa Tatsushi Kawada Keiichiro Mori Sung Ryul Shim Hadi Mostafaei Reza Sari Motlagh Fahad Quhal Ekaterina Laukhtina Markus von Deimling Alberto Bianchi Muhammad Majdoub Maximilian Pallauf Benjamin Pradere Takahiro Kimura Shahrokh F. Shariat Pawel Rajwa |
| Affiliation: | 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan;3. Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea;4. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia;5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy;7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, Hillel Yaffe Medical Center, Hadera, Israel;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France;9. Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria |
| Abstract: | ObjectiveTo 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.MethodsThree 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.ResultsOverall, 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.ConclusionsAmong 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. |
| Keywords: | performance status Eastern Cooperative Oncology Group metastatic hormone-sensitive prostate cancer non-metastatic castration-resistant prostate cancer metastatic castration-resistant prostate cancer |