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Review
. 2018 Dec 13:11:9061-9070.
doi: 10.2147/OTT.S187239. eCollection 2018.

The effect of additional chemotherapy on high-risk prostate cancer: a systematic review and meta-analysis

Junru Chen  1 , Xingming Zhang  1 , Guangxi Sun  1 , Jinge Zhao  1 , Jiandong Liu  1 , Peng Zhao  1 , Jindong Dai  1 , Pengfei Shen  1 , Hao Zeng  1
Affiliations
Review

The effect of additional chemotherapy on high-risk prostate cancer: a systematic review and meta-analysis

Junru Chen et al. Onco Targets Ther. .

Abstract

Objective: The role of additional chemotherapy in the treatment of high-risk prostate cancer (PCa) remains a controversy. This meta-analysis aimed to investigate the effect of additional chemotherapy on high-risk PCa.

Methods: Randomized controlled trials (RCTs) about additional chemotherapy for high-risk PCa were searched in PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. We extracted HRs of overall survival (OS) and progression-free survival (PFS) for each trial and performed the meta-analysis using Review Manager 5.3.

Results: Eight RCTs involving 4,007 patients were included. Data from four trials, which could collect OS, showed that additional chemotherapy could not significantly improve the OS in patients with high-risk PCa (HR: 0.93; 95% CI: 0.79-1.09; P=0.37). However, the pooled analysis suggested significantly longer PFS in high-risk PCa patients treated with additional chemotherapy (HR: 0.81; 95% CI: 0.74-0.90; P<0.0001). The meta-analysis showed additional chemotherapy to androgen-deprivation therapy improved PFS (HR: 0.82; 95% CI: 0.74-0.91; P=0.0002). Greater improvement in PFS was found in high-risk PCa patients treated with additional docetaxel-based chemotherapy (HR: 0.73; 95% CI: 0.64-0.83; P<0.00001). No prolonged PFS was observed in high-risk PCa patients with non-docetaxel-based chemotherapy (HR: 0.97; 95% CI: 0.83-1.14; P=0.74).

Conclusion: Additional chemotherapy, especially docetaxel-based chemotherapy, could significantly improve the PFS in high-risk PCa patients. More evidence about the effect of additional chemotherapy on OS is needed. Further investigations in PCa should also focus on the suitable population for chemotherapy as well as optimal use of chemotherapy.

Keywords: chemotherapy; high-risk; meta-analysis; prostate cancer; systematic review.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the selection process of eligible trials.
Figure 2
Figure 2
The risk of bias of the included trials.
Figure 3
Figure 3
Effects of additional chemotherapy on overall survival.
Figure 4
Figure 4
Effects of additional chemotherapy on PFS (subgroup analysis according to chemotherapy combining with ADT or not). Abbreviations: ADT, androgen deprivation therapy; PFS, progression-free survival; RP, radical prostatectomy; RT, radiation therapy.
Figure 5
Figure 5
Effects of additional chemotherapy on progression-free survival (subgroup analysis according to the drugs for chemotherapy: docetaxel-based and non-docetaxel-based chemotherapy).
See this image and copyright information in PMC

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