Hormone naïve metastatic prostate cancer: can results of meta-analyses of aggregate data convince oncologists to expand the role of docetaxel?

Aim: Results of trial investigating addition of docetaxel (D) to androgen deprivation therapy (ADT) in patients with hormone naïve metastatic prostate cancer have been inconsistent. Thus meta-analysis is expected to settle the controversy.Methods: In this report, the authors highlight the results of randomized phase III trials and the results of recently published aggregated data meta-analysis (ADM) performed by the same investigators of these trials. In addition, the authors present and discuss the results of their own independent ADM. Three randomized phase III trials were identified. Only patients with metastatic (M1) disease were included. Comprehensive meta-analysis version 3.0 was used to perform the ADM. The primary endpoint of interest was overall survival (OS).Results: The trials included a total 2,261 patients with M1 disease. Median follow up ranged between 29 and 50 months. Random effect model showed that ADT+D improved OS compared to ADT alone (Odds Ratio 0.745; 95% Confidence Interval: 0.593-0.937; P = 0.012).Conclusion: The independent ADM confirms the OS benefit of adding D to ADT in patients with hormone naïve metastatic prostate cancer. Individual patient meta-analysis is likely to identify subgroups of patients who benefit more from this approach