Salvage therapies for biochemical recurrence after definitive local treatment: a systematic review, meta-analysis, and network meta-analysis

IF 5.1 2区 医学 Q1 ONCOLOGY
Akihiro Matsukawa, Takafumi Yanagisawa, Tamas Fazekas, Marcin Miszczyk, Ichiro Tsuboi, Mehdi Kardoust Parizi, Ekaterina Laukhtina, Jakob Klemm, Stefano Mancon, Keiichiro Mori, Shoji Kimura, Jun Miki, Juan Gomez Rivas, Timo F. W. Soeterik, Thomas Zilli, Derya Tilki, Steven Joniau, Takahiro Kimura, Shahrokh F. Shariat, Pawel Rajwa
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引用次数: 0

Abstract

Purpose

Recent advancements in the management of biochemical recurrence (BCR) following local treatment for prostate cancer (PCa), including the use of androgen receptor signaling inhibitors (ARSIs), have broadened the spectrum of therapeutic options. We aimed to compare salvage therapies in patients with BCR after definitive local treatment for clinically non-metastatic PCa with curative intent.

Methods

In October 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled trials (RCTs) and prospective studies reporting data on the efficacy of salvage therapies in PCa patients with BCR after radical prostatectomy (RP) or radiation therapy (RT). The primary endpoint was metastatic-free survival (MFS), and secondary endpoints included progression-free survival (PFS) and overall survival (OS).

Results

We included 19 studies (n = 9117); six trials analyzed RT-based strategies following RP, ten trials analyzed hormone-based strategies following RP ± RT or RT alone, and three trials analyzed other agents. In a pairwise meta-analysis, adding hormone therapy to salvage RT significantly improved MFS (HR: 0.69, 95% CI: 0.57–0.84, p < 0.001) compared to RT alone. Based on treatment ranking analysis, among RT-based strategies, the addition of elective nodal RT and androgen deprivation therapy (ADT) was found to be the most effective in terms of MFS. On the other hand, among hormone-based strategies, enzalutamide + ADT showed the greatest benefit for both MFS and OS.

Conclusions

The combination of prostate bed RT, elective pelvic irradiation, and ADT is the preferred treatment for eligible patients with post-RP BCR based on our analysis. In remaining patients, or in case of post-RT recurrence, especially for those with high-risk BCR, the combination of ADT and ARSI should be considered.

Abstract Image

局部明确治疗后生化复发的挽救疗法:系统综述、荟萃分析和网络荟萃分析
目的最近在前列腺癌(PCa)局部治疗后生化复发(BCR)治疗方面取得的进展,包括雄激素受体信号转导抑制剂(ARSI)的使用,扩大了治疗选择的范围。方法2023年10月,我们查询了PubMed、Scopus和Web of Science数据库,以确定随机对照试验(RCT)和前瞻性研究,这些研究报告了根治性前列腺切除术(RP)或放射治疗(RT)后出现BCR的PCa患者接受挽救疗法的疗效数据。主要终点是无转移生存期(MFS),次要终点包括无进展生存期(PFS)和总生存期(OS)。结果我们纳入了19项研究(n = 9117);6项试验分析了RP术后以RT为基础的策略,10项试验分析了RP±RT术后或仅RT术后以激素为基础的策略,3项试验分析了其他药物。在一项配对荟萃分析中,与单纯 RT 相比,在挽救性 RT 中加入激素治疗可显著改善 MFS(HR:0.69,95% CI:0.57-0.84,p <0.001)。根据治疗排序分析,在以RT为基础的策略中,选择性结节RT和雄激素剥夺疗法(ADT)对MFS最有效。结论根据我们的分析,前列腺床 RT、选择性盆腔照射和 ADT 的组合是符合条件的 RP BCR 后患者的首选治疗方法。对于其余患者,或在 RT 后复发的情况下,尤其是高危 BCR 患者,应考虑 ADT 和 ARSI 联合治疗。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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