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There are emerging data regarding the therapeutic benefit of enzalutamide (ENZ) in the treatment of patients with castration-resistant prostate cancer (CRPC) pretreated with docetaxel and abiraterone acetate. To systematically evaluate the evidence regarding the efficacy of ENZ after docetaxel and abiraterone acetate treatment in CRPC, we performed a pooled analysis of all available studies. Studies that enrolled CRPC patients treated with ENZ after docetaxel and abiraterone acetate treatment were identified using PubMed, Web of Science, SCOPUS, The Cochrane Register of Controlled Trials, and EMBASE. A systematic review was conducted to calculate the pooled response rate (RR) and the 95% confidence interval (CI). Pooled median progression-free survival (PFS) and overall survival (OS), weighted on the number of patients of each of the selected trials, were also calculated. We tested for significant heterogeneity using the Cochran χ(2) test and the I(2) index. Ten publications were selected for inclusion in this analysis. The number of included patients was 536 (range, 23-137). Overall, the pooled RR (reduction of prostate-specific antigen by > 50%) was 22.9% (95% CI, 19.3%-27.1%). The median PFS was 3.1 months (range, 1.4-4.9 months). The median OS was 8.3 months (range, 2.85-10.6 months). In patients sensitive to abiraterone, the RR to ENZ was 35% (95% CI, 27.2%-43.7%). ENZ is moderately effective in CRPC patients who were pretreated with chemotherapy and abiraterone acetate. The greater benefit is confined in patients who responded to abiraterone acetate. Further prospective evaluations of ENZ are required and the mechanisms of resistance have to be better understood.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Enzalutamide, abiraterone-acetate, and cabazitaxel are licensed post-docetaxel treatments of metastatic castration-resistant prostate cancer (mCRPC) in Hungary. The objectives of the study were to assess the efficacy and safety of post-docetaxel enzalutamide treatment and to compare it with abiraterone and with cabazitaxel, using Medline-based systematic literature search, and meta-analysis of randomised controlled trials (RCT). Overall 3 RCTs were included, one for each substance. Compared to placebo, enzalutamide proved significant efficacy in each primary and secondary endpoint. Enzalutamide extended median overall survival by 4.8 months. Due to lack of a common comparator in the cabazitaxel trial, only enzalutamide and abiraterone were involved in an indirect comparison. No significant difference was identified either in the primary endpoint (overall survival) (HR: 0.97, 95% CI: 0.75-1.25) or in frequencies of adverse events between these two treatments. However, enzalutamide was significantly more efficacious than abiraterone in 3 secondary endpoints: time to prostate-specific antigen (PSA) progression (HR: 0.43, 95% CI: 0.31-0.59), radiographic progression-free survival (HR: 0.6, 95% CI: 0.5-0.72), and PSA response rate (RR: 7.48, 95% CI: 2.83-19.72). Enzalutamide therapy proved clinical efficacy and safety in patients with post-docetaxel mCRPC. In the indirect comparison, efficacy and safety of abiraterone and enzalutamide were found to be similar.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

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