A Systematic Literature Review (SLR) and Network Meta-Analysis (NMA) of Pharmaceutical Interventions for First-Line (1L) Patients with Asymptomatic/Mildly Symptomatic Metastatic Castration-Resistant Prostate Cancer (MCRPC)
Author(s)
Castro E1, Samjoo I2, Ellis J2, Paganelli S2, Craigie S2, Nazari J3, Niyazov A3
1Hospital Universitario 12 de Octubre, Madrid, Spain, 2EVERSANA, Burlington, ON, Canada, 3Pfizer Inc., New York, NY, USA
Presentation Documents
OBJECTIVES: Talazoparib in combination with enzalutamide (TALA+ENZA) has demonstrated benefit for the 1L treatment of patients with mCRPC (TALAPRO-2; NCT03395197). The efficacy and safety of traditional and recently developed treatments compared with TALA+ENZA remain unclear and few studies have compared treatments directly. We estimated the relative efficacy and safety of TALA+ENZA in 1L mCRPC by conducting an SLR and NMA.
METHODS: We searched MEDLINE®, Embase, and Cochrane using Ovid® from inception to October 2022; and key grey literature sources to identify randomized controlled trials (RCTs) evaluating treatments for 1L mCRPC. Bayesian random-effects NMAs for radiographic progression-free survival (rPFS) and overall survival (OS) were conducted using the most recent data cutoff for TALAPRO-2 and comparators. Safety outcomes were also investigated. Comparators of particular interest were olaparib plus abiraterone acetate (OLAP+AAP), enzalutamide (ENZA), abiraterone acetate plus prednisone (AAP), and docetaxel 75 mg/m2 plus prednisone (DOC75+PS).
RESULTS: Thirty-eight RCTs with published data at the time of the review were considered for NMAs. The rPFS network included 13 RCTs and 14 treatments. TALA+ENZA was associated with numerical improvements in rPFS vs OLAP+AAP (hazard ratio [HR]: 0.560; 95% credible interval [CI]: 0.246, 1.315); and statistically significant improvements vs ENZA (HR: 0.628; 95% CI: 0.401, 0.995) and vs AAP (HR: 0.383; 95 % CI: 0.187, 0.778). rPFS for DOC75+PS was not reported. The OS network included 20 RCTs and 18 treatments. TALA+ENZA was associated with numerical improvements in OS vs OLAP+AAP (HR: 0.861; 95% CI: 0.395, 1.617), ENZA (HR: 0.839; 95 % CI: 0.579, 1.234), AAP (HR: 0.695; 95% CI: 0.353, 1.185), and DOC75+PS (HR: 0.933; 95% CI: 0.456, 1.748).
CONCLUSIONS: Results suggest that TALA+ENZA has an efficacy profile superior to other 1L treatments approved or expected to be approved across all endpoints analyzed, indicating its therapeutic potential for the treatment of patients in 1L mCRPC.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
CO135
Topic
Clinical Outcomes, Study Approaches
Topic Subcategory
Comparative Effectiveness or Efficacy, Meta-Analysis & Indirect Comparisons
Disease
Drugs, Oncology