背景:检测乳腺癌基因1/2(BRCA)的突变已成为临床医生的新决策工具。具有致病性BRCA突变的转移性去势抵抗性前列腺癌(mCRPC)患者可以受益于聚(ADP-核糖)聚合酶抑制剂(PARPi)和铂治疗,而突变对卡巴他赛和前列腺特异性膜抗原(PSMA)-配体治疗敏感性的影响目前尚不清楚.
目的:为了评估PARPi的疗效,铂金,卡巴他赛,和PSMA-配体治疗BRCA阳性mCRPC。
方法:数据库在2022年2月进行了查询。我们通过使用比例和个体患者数据进行数据合成。对于前列腺特异性抗原(PSA)反应率(从基线[PSA50]下降≥50%)评估,我们将事件发生率与95%置信区间(CI)合并。使用混合效应Cox比例风险模型和单臂随机效应分析对个体患者数据进行无进展(PFS)和总体(OS)生存分析。提供汇集的中位数。
结果:我们纳入了23项符合条件的研究,共901例BRCA阳性mCRPC患者。PARPi和铂的PSA50反应率为69%(CI:53-82%),和74%(CI:49-90%),分别。OS数据分析显示PARPi和铂类治疗之间没有差异(风险比:0.86;CI:0.49-1.52;p=0.6)。单臂OS和PFS分析揭示了不同PARPis之间的相似性;合并的PFS和OS中位数分别为9.7mo(CI:8.1-12.5)和17.4mo(CI:12.7-20.1),分别。
结论:我们的数据显示不同的PARPis在PFS和OS方面同样有效。此外,我们发现PARPi和铂类药物在PSA50反应率和OS方面具有可比性,强调铂是BRCA阳性mCRPC患者的有效治疗选择。然而,比较这些药物的前瞻性干预研究对于提供更高水平的证据至关重要。
结果:在本报告中,我们发现,不同的聚(ADP-核糖)聚合酶抑制剂具有相似的疗效,铂是BRCA阳性转移性去势耐药前列腺癌患者的有效治疗选择.
BACKGROUND: Testing for mutations in Breast Cancer Gene 1/2 (BRCA) has emerged as a novel decision-making tool for clinicians. Patients with metastatic castration-resistant prostate cancer (mCRPC) harboring pathogenic BRCA mutations can benefit from poly (ADP-ribose) polymerase inhibitor (PARPi) and platinum treatments, whereas the impact of the mutation on sensitivity to cabazitaxel and prostate-specific membrane antigen (PSMA)-ligand therapy is currently unknown.
OBJECTIVE: To assess the efficacy of PARPi, platinum, cabazitaxel, and PSMA-ligand therapies in BRCA-positive mCRPC.
METHODS: Databases were queried in February 2022. We performed data synthesis by using both proportional and individual patient data. For prostate-specific antigen (PSA) response rate (≥50% decrease from baseline [PSA50]) evaluation, we pooled event rates with 95% confidence intervals (CIs). Progression-free (PFS) and overall (OS) survival analyses with individual patient data were performed with the mixed-effect Cox proportional hazard model and single-arm random-effect analysis, providing pooled medians.
RESULTS: We included 23 eligible studies with 901 BRCA-positive mCRPC patients. PSA50 response rates for PARPi and platinum were 69% (CI: 53-82%), and 74% (CI: 49-90%), respectively. Analyses of OS data showed no difference between PARPi and platinum treatments (hazard ratio: 0.86; CI: 0.49-1.52; p = 0.6). The single-arm OS and PFS analyses revealed similarities among different PARPis; pooled PFS and OS medians were 9.7 mo (CI: 8.1-12.5) and 17.4 mo (CI: 12.7-20.1), respectively.
CONCLUSIONS: Our data revealed that different PARPis were similarly effective in terms of PFS and OS. Moreover, we found that PARPi and platinum therapy were comparable in terms of PSA50 response rate and OS, highlighting that platinum is a valid treatment option for BRCA-positive mCRPC patients. However, prospective interventional studies comparing these agents are essential to provide a higher level of evidence.
RESULTS: In this report, we found that different poly (ADP-ribose) polymerase inhibitors had similar efficacy, and platinum was a valid treatment option in BRCA-positive metastatic castration-resistant prostate cancer patients.