Systematic review and meta‐analysis of monotherapy compared with combined androgen blockade for patients with advanced prostate carcinoma
- 11 July 2002
- Vol. 95 (2), 361-376
- https://doi.org/10.1002/cncr.10647
Abstract
The current systematic review and meta-analysis compared monotherapy and combined androgen blockade in the treatment of men with advanced prostate carcinoma. Outcomes of interest included overall, cancer specific, and progression-free survival; time to treatment failure; adverse events; and quality of life. The literature search identified randomized trials comparing monotherapy (orchiectomy and luteinizing hormone-releasing hormone [LHRH] agonists) with combination therapy using orchiectomy or a LHRH agonist plus a nonsteroidal or steroidal antiandrogen. Dual independent review occurred. The meta-analysis used a random effects model. Twenty-one trials compared survival after monotherapy with survival after combined androgen blockade (n = 6871 patients). The meta-analysis found no statistically significant difference in survival at 2 years between patients treated with combined androgen blockade and those treated with monotherapy (20 trials; hazard ratio [HR] = 0.970; 95% confidence interval [95% CI], 0.866–1.087). The authors determined a statistically significant difference in survival at 5 years that favored combined androgen blockade (10 trials; HR = 0.871; 95% CI, 0.805–0.942). For the subgroup of patients with a good prognosis, there was no statistically significant difference in survival. Adverse effects leading to withdrawal from therapy occurred more often with combined androgen blockade. To the authors' knowledge there is little evidence published to date comparing the effects of combined androgen blockade and monotherapy on quality of life, but the single randomized trial that adequately addressed this outcome reported an advantage for monotherapy over combined androgen blockade. A thorough examination of the usefulness of combined androgen blockade must balance the modest increase in expected survival observed at 5 years against the increased risk of adverse effects and the potential for adversely affecting the patient's overall quality of life. [See editorial on pages 209–10, this issue.] Cancer 2002;95:361–76. © 2002 American Cancer Society. DOI 10.1002/cncr.10647Keywords
This publication has 42 references indexed in Scilit:
- Complete Androgen Blockade versus Chemical Castration in Advanced Prostatic Cancer: Analysis of an Italian Multicentre StudyUrologia Internationalis, 1998
- Combined Androgen Blockade in the Treatment of Advanced Prostate Cancer–an OverviewScandinavian Journal of Urology and Nephrology, 1997
- History of LHRH agonist and combination therapy in prostate cancerEndocrine-Related Cancer, 1996
- Bilateral orchidectomy and flutamide versus orchidectomy alone in newly diagnosed patients with metastatic carcinoma of the prostate — an Australian multicentre trialBJU International, 1996
- Goserelin acetate with or without flutamide in the treatment of patients with locally advanced or metastatic prostate cancerEuropean Journal of Cancer, 1993
- A Controlled Trial of Leuprolide with and without Flutamide in Prostatic CarcinomaThe New England Journal of Medicine, 1989
- 10-Jahres-Ergebnisse einer randomisierten Prospektivstudie beim metastasierten ProstatakarzinomAktuelle Urologie, 1987
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Combination therapy with flutamide and castration (LHRH agonist or orchiectomy) in advanced prostate cancer: A marked improvement in response and survivalJournal of Steroid Biochemistry, 1985
- Reporting standards and research strategies for controlled trials: Agenda for the editorControlled Clinical Trials, 1980