title: Androgen-deprivation therapy plus chemotherapy in metastatic hormone-sensitive prostate cancer. A systematic review and meta-analysis of randomized clinical trials.
abstract: To assess the efficacy and toxicity of androgen-deprivation therapy (ADT) plus chemotherapy in patients with hormone-sensitive metastatic prostate cancer.
  
  
  
  Randomized clinical trials were identified after systematic searching of databases and conference proceedings. A random-effect model was used to determine the pooled hazard ratio (HR) for the efficacy outcomes-overall survival (OS), biochemical progression-free survival (PFS), and clinical PFS, according to the inverse-variance method. Heterogeneity was measured using the Q and I(2) statistics. A narrative review was done to explore the major adverse drug reactions reported for each trial.
  
  
  
  After systematic searching, we included 6 trials (n = 2,675) in this meta-analysis. Estramustine-based chemotherapy plus ADT was not associated with improved OS (HR = 0.64; 95% CI: 0.22-1.89; P = 0.42). In contrast, docetaxel plus ADT was associated with improved OS (HR = 0.75; 95% CI: 0.61-0.91; P = 0.004) and clinical PFS (HR = 0.64; 95% CI: 0.57-0.72; P<0.00001). There was no significant heterogeneity detected among trials. Regarding adverse drug reactions grade 3 or higher, neutropenia was the most frequent side effect reported in a range from 12% to 32%.
  
  
  
  The addition of docetaxel-based chemotherapy to ADT improves OS and clinical PFS in hormone-sensitive metastatic prostate cancer.
authors.affiliation: Departamento de Oncología Médica, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica. Electronic address: allan.ramos@ucr.ac.cr.
authors.forename: Allan
authors.initials: A
authors.lastname: Ramos-Esquivel
authors.affiliation: Departamento de Farmacia, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Departamento de Oncología Médica, Hospital San Juan de Dios, Universidad de Costa Rica, San José, Costa Rica.
authors.forename: Zenén
authors.initials: Z
authors.lastname: Zeledón
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic
chemical_list: D000726:Androgen Antagonists
keywords: Androgen; Cancer; Castration; Chemotherapy; Drug therapy; Prostate