比较阿比特龙和恩杂鲁胺在转移性去势抵抗性前列腺癌中的临床疗效和安全性：系统评价和荟萃分析。,Journal of Oncology Pharmacy Practice

两种新药阿比特龙和恩杂鲁胺最近已显示出对去势抵抗性前列腺癌患者生存的有益作用。我们在现实世界中系统地回顾了阿比特龙和恩杂鲁胺在转移性去势抵抗性前列腺癌中的疗效和安全性。

截止至2019年3月6日，来自Embase的Coprane Web of Science的PubMed进行了搜索。搜索了会议中的可用文章。终点为前列腺特异性抗原反应，总生存期，无进展生存期，发生任何不良事件的患者人数。

纳入了14个队列研究，涉及3469名参与者。汇总结果显示，接受恩杂鲁胺治疗的患者的前列腺特异性抗原应答高于阿比特龙（790例患者，优势比（OR）为0.47，95％置信区间（CI）为0.29–0.77，P = 0.003，I 2 = 59％）。与阿比特龙相比，恩扎鲁胺与不良事件发生率显着相关（730例患者，或0.35，95％CI 0.13-0.92，P = 0.03，I 2 = 65％）。在认知障碍方面，阿比特龙和恩杂鲁胺之间无统计学差异（1856例患者，或0.90，95％CI 0.29–2.76，P = 0.85，I 2= 5％）。与阿比特龙（2477例，OR 0.46，95％CI 0.34-0.63，P ＜0.00001，I 2 = 0％）相比，恩杂鲁胺与疲劳风险增加显着相关。

我们的研究结果表明，enzalutamide对转移性去势抵抗性前列腺癌的患者比阿比特龙更有效，但与副作用（尤其是疲劳）的风险显着相关。

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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.

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.

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%).

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.