Tratamiento del cáncer de próstata no metastásico resistente a la castración: una revisión sistemática y un metaanálisis

Resumen

Background: Patients with non-metastatic prostate cancer treated with androgen deprivation therapy develop castration resistance after an average of 19 months. Non-metastatic castration-resistant prostate cancer (M0CRPC) refers to biochemical progression despite medical or surgical castration.

Purpose: To determine the effectiveness of the available interventions for treating non-metastatic castration-resistant prostate cancer (M0CRPC).

Methods: We performed a search strategy in MEDLINE via Ovid, EMBASE, CENTRAL, and LILACS. We included phase II and phase III clinical trials whose primary objective was to evaluate the effectiveness of the intervention in a patient with M0CRPC (primary outcome metastasis-free survival). We excluded studies that included patients with multimodal treatment. We performed the statistical analysis in R and Review Manager 5.3 (RevMan 5.3).

Results: We found a total of 1376 studies. After screening, we selected three studies for qualitative analysis. In the analysis of the three included studies, a total of 4117 patients older than 18 years had non-metastatic castration-resistant prostate cancer. The interventions evaluated were apalutamide, enzalutamide, and darolutamide. All trials demonstrated a significant increase in MFS with the evaluated intervention in patients with nmCRPC. The indirect comparison showed that the three option is better than placebo, but apalutamide and enzalutamide are better than darolutamide.

Conclusion: In non-metastatic patients, CRPC apalutamide and enzalutamide provide a lower risk of metastasis than darolutamide. Also, there were no differences between apalutamide and enzalutamide.