Comparing the clinical efficacy and safety of abiraterone and enzalutamide in metastatic castration-resistant prostate cancer: A systematic review and meta-analysis.

Abstract

BACKGROUND:

Two new drugs, abiraterone and enzalutamide, had recently shown beneficial effects on survival in patients with metastatic castration-resistant prostate cancer. We systematically reviewed the efficacy and safety of abiraterone and enzalutamide in metastatic castration-resistant prostate cancer in real-world practice.

METHODS:

A search from PubMed, Web of Science, Cochrane, Embase was conducted up to 6 March 2019. Available articles from conferences were searched. The endpoint was prostate-specific antigen response, overall survival, progression-free survival, number of patients with any adverse event.

RESULTS:

Fourteen cohort studies involving 3469 participants were included. Pooled result showed that prostate-specific antigen response was higher for patients receiving enzalutamide than abiraterone (790 patients, odds ratio (OR) 0.47, 95% confidence interval (CI) 0.29-0.77, P = 0.003, I2=59%). Enzalutamide was significantly associated with increased adverse events rate in comparison with abiraterone (730 patients, OR 0.35, 95%CI 0.13-0.92, P = 0.03, I2=65%). There was no statistical difference between abiraterone and enzalutamide with respect to perceived cognitive impairments (1856 patients, OR 0.90, 95%CI 0.29-2.76, P = 0.85, I2=5%). Enzalutamide was significantly associated with increased fatigue risk in comparison with abiraterone (2477 patients, OR 0.46, 95%CI 0.34-0.63, P＜0.00001, I2=0%).

CONCLUSIONS:

Our results demonstrated that enzalutamide was more efficacious than abiraterone for patients with metastatic castration-resistant prostate cancer, but was associated with a significantly elevated risk of side effects, particularly fatigue.

• Authors: Xin Wang, Hui Yang, Xiaopeng Hu, Wei Wang, Xiaojia Yu, Shihui Wang, Xiaodong Zhang, Lihong Liu
• Journal: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners (J Oncol Pharm Pract) Vol. 27 Issue 3 Pg. 614-622 (Apr 2021) ISSN: 1477-092X [Electronic] England
• PMID: 32529950 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Androstenes
• Benzamides
• Nitriles
• Phenylthiohydantoin
• enzalutamide
• Prostate-Specific Antigen
• abiraterone

Topics

• Aged
• Androstenes (adverse effects, therapeutic use)
• Benzamides
• Cohort Studies
• Humans
• Male
• Nitriles
• Phenylthiohydantoin (adverse effects, analogs & derivatives, therapeutic use)
• Progression-Free Survival
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms, Castration-Resistant (blood, diagnosis, drug therapy)
• Treatment Outcome