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Título

IMMUNE CHECKPOINT INHIBITORS IN METASTATIC CASTRATION-RESISTANT PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Resumo

Introduction:Prostate cancer ranks second among the most prevalent tumors in men globally. While localized disease can often be effectively treated with current strategies, metastatic castration-resistant prostate cancer presents a challenging prognosis with limited treatment options, demading the exploration of new approaches. Immune checkpoint inhibitors, commonly used for tumors with high somatic mutation rates, have emerged as a novel biologic treatment option for this disease.While immunotherapy, particularly with immune checkpoint inhibitors, holds promise, real-world data on its safety and efficacy remains inconclusive,
Methods:A systematic search was conducted in PubMed, Embase, and Cochrane Library databases from January 2010 to December 2023 including the keywords "PD-1 inhibitor”,"“PD-L1 inhibitor”, “CTLA-4 inhibitor "metastatic castration-resistant prostate cancer," and "immune checkpoint inhibitors." Phase I, II and III clinical trials reporting on the efficacy and safety of immune checkpoint inhibitors in metastatic castration-resistant prostate cancer were included. We performed statistical analysis that included calculating pooled overall survival rate, objective response rate, prostate specific antigen response and adverse event rates using a random-effects model. The data was calculated and pooled using the software STATA version 12.0 and R software version 3.6.0

Results:The initial search identified 2178 articles, of which 10 met the inclusion criteria and were included in the meta-analysis. The pooled analysis revealed an 1-year overall survival rate of 55.6% (95% CI: 47.2–65.3%) and a objective response rate of 12% (95% CI: 5.68-18%). The prostate specific antigen response rate was 17.3% (95% CI: 13.6-23.2%) The incidence of grade 3 or higher treatment-related adverse events was 41.8% (95% CI: 37.5–50.3%)

Conclusion: Metastatic castration-resistant prostate cancer remains incurable, with treatment goals being focused on extending survival and enhancing patients' quality of life. In our meta-analysis, immune checkpoint inhibitors demonstrated modest efficacy with manageable safety profiles. However, it is important to notice that the risk of grade 3 adverse events reached up to 41.8%. Nonetheless, while our findings suggests that immunotherapy holds potential for new successful treatment strategies, there is the need for further exploration and refinement of immunotherapeutic strategies in this challenging malignancy.

Área

Câncer de Próstata Metastático