Systemic review and meta-analysis of first-line systemic treatment options for metastatic castration-sensitive prostate cancer

The most effective systemic first-line treatment for metastatic castration-sensitive prostate cancer (mCSPC) is not known. A systematic review and meta-analysis of 10 clinical trials with 11,043 mCSPC patients found that abiraterone triplet therapy (abiraterone plus docetaxel plus androgen derivation therapy) was potentally the most efficacious treatment for high-volume disease, and was associated with significant improvement in survival compared with doublet regimens. For low-volume and metachronous disease, androgen pathway inhibitor doublet therapies were ranked potentially as the most efficacious treatment options and were not significantly different from triplet regimens.The authors conclude that triplet therapy may be preferred for de novo high-volume disease, while API doublet therapies may be preferred for recurrent low-volume disease.