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Comparative efficacy, tolerability, and survival outcomes of various radiopharmaceuticals in castration-resistant prostate cancer with bone metastasis: a meta-analysis of randomized controlled trials.

Tunio M, Al Asiri M, Al Hadab A, Bayoumi Y - Drug Des Devel Ther (2015)

Bottom Line: A meta-analysis was conducted to assess the impact of radiopharmaceuticals (RPs) in castration-resistant prostate cancer (CRPC) on pain control, symptomatic skeletal events (SSEs), toxicity profile, quality of life (QoL), and overall survival (OS).Pooled data were expressed as odds ratio (OR), with 95% confidence intervals (CIs; Mantel-Haenszel fixed-effects model).Eight RCTs with a total patient population of 1,877 patients were identified.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.

ABSTRACT

Background: A meta-analysis was conducted to assess the impact of radiopharmaceuticals (RPs) in castration-resistant prostate cancer (CRPC) on pain control, symptomatic skeletal events (SSEs), toxicity profile, quality of life (QoL), and overall survival (OS).

Materials and methods: The PubMed/MEDLINE, CANCERLIT, EMBASE, Cochrane Library database, and other search engines were searched to identify randomized controlled trials (RCTs) comparing RPs with control (placebo or radiation therapy) in metastatic CRPC. Data were extracted and assessed for the risk of bias (Cochrane's risk of bias tool). Pooled data were expressed as odds ratio (OR), with 95% confidence intervals (CIs; Mantel-Haenszel fixed-effects model).

Results: Eight RCTs with a total patient population of 1,877 patients were identified. The use of RP was associated with significant reduction in pain intensity and SSE (OR: 0.63, 95% CI: 0.51-0.78, I(2)=27%, P,0.0001), improved QoL (OR: 0.71, 95% CI: 0.55-0.91, I(2)=65%, three trials, 1,178 patients, P=0.006), and a minimal improved OS (OR: 0.84, 95% CI: 0.64-1.04, I(2)=47%, seven trials, 1,845 patients, P=0.11). A subgroup analysis suggested an improved OS with radium-223 (OR: 0.68, 95% CI: 0.51-0.90, one trial, 921 patients) and strontium-89 (OR: 0.21, 95% CI: 0.05-0.91, one trial, 49 patients). Strontium-89 (five trials) was associated with increased rates of grade 3 and 4 thrombocytopenia (OR: 4.26, 95% CI: 2.22-8.18, P=0.01), leucopenia (OR: 7.98, 95% CI: 1.82-34.95, P=0.02), pain flare (OR: 6.82, 95% CI: 3.42-13.55, P=0.04), and emesis (OR: 3.61, 95% CI: 1.76-7.40, P=0.02).

Conclusion: The use of RPs was associated with significant reduction in SSEs and improved QoL, while the radium-223-related OS benefit warrants further large, RCTs in docetaxel naive metastatic CRPC patients.

No MeSH data available.


Related in: MedlinePlus

Quality of life (multiple scales).Note: Horizontal lines represent point estimates varying in size according to the weightage, and 95% confidence intervals.Abbreviations: CI, confidence interval; df, degrees of freedom; RP, radiopharmaceutical; χ2,; Z, Z score; M–H, Mantel–Haenszel.
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f4-dddt-9-5291: Quality of life (multiple scales).Note: Horizontal lines represent point estimates varying in size according to the weightage, and 95% confidence intervals.Abbreviations: CI, confidence interval; df, degrees of freedom; RP, radiopharmaceutical; χ2,; Z, Z score; M–H, Mantel–Haenszel.

Mentions: Three RCTs with 1,178 patients examined the QoL as one of the outcomes. The overall functional mobility and QoL were significantly improved in patients treated with RPs (P=0.006). The pooled OR was 0.71 (95% CI: 0.55–0.91, I2=65%) as shown in Figure 4.


Comparative efficacy, tolerability, and survival outcomes of various radiopharmaceuticals in castration-resistant prostate cancer with bone metastasis: a meta-analysis of randomized controlled trials.

Tunio M, Al Asiri M, Al Hadab A, Bayoumi Y - Drug Des Devel Ther (2015)

Quality of life (multiple scales).Note: Horizontal lines represent point estimates varying in size according to the weightage, and 95% confidence intervals.Abbreviations: CI, confidence interval; df, degrees of freedom; RP, radiopharmaceutical; χ2,; Z, Z score; M–H, Mantel–Haenszel.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590341&req=5

f4-dddt-9-5291: Quality of life (multiple scales).Note: Horizontal lines represent point estimates varying in size according to the weightage, and 95% confidence intervals.Abbreviations: CI, confidence interval; df, degrees of freedom; RP, radiopharmaceutical; χ2,; Z, Z score; M–H, Mantel–Haenszel.
Mentions: Three RCTs with 1,178 patients examined the QoL as one of the outcomes. The overall functional mobility and QoL were significantly improved in patients treated with RPs (P=0.006). The pooled OR was 0.71 (95% CI: 0.55–0.91, I2=65%) as shown in Figure 4.

Bottom Line: A meta-analysis was conducted to assess the impact of radiopharmaceuticals (RPs) in castration-resistant prostate cancer (CRPC) on pain control, symptomatic skeletal events (SSEs), toxicity profile, quality of life (QoL), and overall survival (OS).Pooled data were expressed as odds ratio (OR), with 95% confidence intervals (CIs; Mantel-Haenszel fixed-effects model).Eight RCTs with a total patient population of 1,877 patients were identified.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.

ABSTRACT

Background: A meta-analysis was conducted to assess the impact of radiopharmaceuticals (RPs) in castration-resistant prostate cancer (CRPC) on pain control, symptomatic skeletal events (SSEs), toxicity profile, quality of life (QoL), and overall survival (OS).

Materials and methods: The PubMed/MEDLINE, CANCERLIT, EMBASE, Cochrane Library database, and other search engines were searched to identify randomized controlled trials (RCTs) comparing RPs with control (placebo or radiation therapy) in metastatic CRPC. Data were extracted and assessed for the risk of bias (Cochrane's risk of bias tool). Pooled data were expressed as odds ratio (OR), with 95% confidence intervals (CIs; Mantel-Haenszel fixed-effects model).

Results: Eight RCTs with a total patient population of 1,877 patients were identified. The use of RP was associated with significant reduction in pain intensity and SSE (OR: 0.63, 95% CI: 0.51-0.78, I(2)=27%, P,0.0001), improved QoL (OR: 0.71, 95% CI: 0.55-0.91, I(2)=65%, three trials, 1,178 patients, P=0.006), and a minimal improved OS (OR: 0.84, 95% CI: 0.64-1.04, I(2)=47%, seven trials, 1,845 patients, P=0.11). A subgroup analysis suggested an improved OS with radium-223 (OR: 0.68, 95% CI: 0.51-0.90, one trial, 921 patients) and strontium-89 (OR: 0.21, 95% CI: 0.05-0.91, one trial, 49 patients). Strontium-89 (five trials) was associated with increased rates of grade 3 and 4 thrombocytopenia (OR: 4.26, 95% CI: 2.22-8.18, P=0.01), leucopenia (OR: 7.98, 95% CI: 1.82-34.95, P=0.02), pain flare (OR: 6.82, 95% CI: 3.42-13.55, P=0.04), and emesis (OR: 3.61, 95% CI: 1.76-7.40, P=0.02).

Conclusion: The use of RPs was associated with significant reduction in SSEs and improved QoL, while the radium-223-related OS benefit warrants further large, RCTs in docetaxel naive metastatic CRPC patients.

No MeSH data available.


Related in: MedlinePlus