A net-work meta-analysis of the cardiac safety for next-generation hormonal agents in treating castration-resistant prostate cancer: How to choose drugs appropriately?

Crit Rev Oncol Hematol. 2024 Apr:196:104273. doi: 10.1016/j.critrevonc.2024.104273. Epub 2024 Feb 20.

Abstract

Background: Researchers have shown that using next-generation hormonal agents (NHA) for castration-resistant prostate cancer (CRPC) would lead to increased risk of cardiac adverse effects, making clinician choices more complex.

Methods: We systematically searched Pubmed, Cochrane Library, and Embase databases for research published before October 2022. Agents were ranked according to their effectiveness based on cardiac adverse effects using the surface under the cumulative ranking curve.

Results: A total of 21 Randomized Controlled Trials (RCT) with 19, 083 patients were included in present study. Our results showed that abiraterone and enzalutamide could lead to a significantly higher hypertension rate compared with placebo; whereas no significant difference was detected between four NHAs and placebo in ischemic heart disease incidence. All four NHAs could significantly increase the risk of cardiotoxicity.

Conclusions: NHAs are generally acceptable in terms of cardiovascular disease compared to placebo in patients with CRPC.

Keywords: Androgen deprivation therapy; Cardiovascular disease; Prostate cancer.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Review

MeSH terms

  • Antineoplastic Agents, Hormonal / adverse effects
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Cardiotoxicity / epidemiology
  • Cardiotoxicity / etiology
  • Humans
  • Male
  • Network Meta-Analysis*
  • Prostatic Neoplasms, Castration-Resistant* / drug therapy
  • Prostatic Neoplasms, Castration-Resistant* / pathology
  • Randomized Controlled Trials as Topic

Substances

  • Antineoplastic Agents, Hormonal