Results of a recent systematic review and meta-analysis could help clinicians decide which therapeutic choices to use for the first-line treatment of men with metastatic castration-sensitive prostate cancer (mCSPC).

The study compared triplet and doublet therapies using data from 10 phase 3 randomized controlled trials with 11,043 patients evaluating first-line treatment options for mCSPC.

Investigators concluded that triplet therapy may be preferred for de novo high-volume disease and doublet therapy may be preferred for recurrent low-volume disease, according to findings published in JAMA Oncology.

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Specifically, triplet therapy with abiraterone combined with docetaxel and androgen deprivation therapy (ADT) is potentially the most efficacious treatment for men with high-volume disease, Irbaz Bin Riaz, MD, PhD, of the Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School in Boston, Massachusetts, and colleagues reported. For low-volume disease, the investigators ranked androgen pathway inhibitor (API) doublet therapies as potentially the most efficacious treatments. “Using mixed treatment comparison methods, we provided the most up-to-date evidence for performance of triplet therapy compared with API-based doublets, a question not answered in clinical trials but paramount to clinical practice and design of future clinical trials,” the investigators wrote.

For the overall population, data suggest that the death risk associated with darolutamide and abiraterone triplet therapies (each drug combined with docetaxel plus ADT) was 32% and 25% lower, respectively, compared with doublet therapy with docetaxel plus ADT, but did not differ significantly with API doublet therapy.

Among patients with high-volume disease, abiraterone triplet therapy was significantly associated with a 28% reduction in death risk compared with docetaxel plus ADT doublet therapy, according to the investigators. Overall survival with abiraterone triple therapy, however, did not differ significantly from doublet API therapy (abiraterone, enzalutamide, or apalutamide plus ADT).

Among men with low-volume disease, abiraterone triplet therapy may not improve overall survival compared with any of the doublet therapies.

“The findings of this systematic review and meta-analysis indicate that the decision of treatment intensification with triplet therapy for patients with mCSPC must be considered carefully by accounting for the volume of disease, the timing of metastatic presentation, and API doublet options with significant survival benefit and fitness for chemotherapy,” the authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference Riaz IB, Naqvi SAA, He H, et al. First-line systemic treatment options for metastatic castration-sensitive prostate cancer. JAMA Oncol. Published online March 2, 2023. doi:10.1001/jamaoncol.2022.7762

This article originally appeared on Renal and Urology News