Comparison of Abiraterone Acetate and Docetaxel with Androgen Deprivation Therapy in High-risk and Metastatic Hormone-naïve Prostate Cancer: A Systematic Review and Network Meta-analysis

Christopher J.D. Wallis, Zachary Klaassen, Bimal Bhindi, Hanan Goldberg, Thenappan Chandrasekar, Ann M. Farrell, Stephen A. Boorjian, Girish S. Kulkarni, Robert Jeffrey Karnes, Raj Satkunasivam

Research output: Contribution to journalReview articlepeer-review

89 Scopus citations


Context: Randomized clinical trials have recently examined the benefit of adding docetaxel or abiraterone to androgen deprivation therapy (ADT) in hormone-naïve advanced prostate cancer (PCa). Objective: To perform a systematic review and network meta-analysis of randomized clinical trials, indirectly evaluating overall survival (OS) for men treated with abiraterone acetate plus prednisone/prednisolone with ADT (Abi-ADT) versus docetaxel with ADT (Doce-ADT) in hormone-naïve high-risk and metastatic PCa. Evidence acquisition: Medline, Embase, Web of Science, Scopus, and databases were searched in August 2017. We pooled results using the inverse variance technique and random-effects models. The Bucher technique for indirect treatment comparison was used to compare Abi-ADT with Doce-ADT. A priori subgroup and sensitivity analyses were performed. Evidence synthesis: Overall, 6067 patients from five trials were included: 1181 (19.5%) patients who received Doce-ADT, 1557 (25.7%) patients who received Abi-ADT, and 3329 (54.9%) patients who received ADT-alone. There was a total of 1921 deaths: 391 in the Doce-ADT group, 353 in the Abi-ADT group, and 1177 in the ADT-only group. The pooled hazard ratio (HR) for OS was 0.75 (95% confidence interval [CI]: 0.63–0.91, I 2 = 51%, 3 trials, 2951 patients) for Doce-ADT versus ADT-alone and 0.63 (95% CI: 0.55–0.72, I 2 = 0%, 2 trials, 3116 patients) for Abi-ADT versus ADT-alone. The indirect comparison of Abi-ADT to Doce-ADT demonstrated no statistically significant difference in OS between these approaches (HR: 0.84, 95% CI: 0.67–1.06). Findings were similar in various a priori subset analyses, including patients with metastatic disease. Bayesian analyses demonstrated comparable results (HR: 0.83, 95% CI: 0.63–1.16). Despite the lack of statistical significance, Surface Under the Cumulative Ranking Analysis demonstrated an 89% probability that Abi-ADT was preferred. Conclusions: We did not identify a significant difference in OS between Abi-ADT and Doce-ADT for men with hormone-naïve high-risk or metastatic PCa, although Bayesian analysis demonstrates a high likelihood that Abi-ADT was preferred. Patient summary: We synthesized the evidence available from studies examining the administration of docetaxel or abiraterone in combination with hormonal therapy for patients with newly diagnosed, advanced prostate cancer. While these studies did not directly compare these agents, we used methodological techniques to indirectly compare them and found no significant difference in overall survival. A number of recent randomized controlled trials have demonstrated the benefit of adding abiraterone and prednisone or docetaxel to androgen deprivation therapy in men with hormone-naïve metastatic prostate cancer. However, which treatment to choose remains unclear. In this network meta-analysis, we found no significant difference in survival between men treated with abiraterone and prednisone and those treated with docetaxel in addition to androgen deprivation therapy.

Original languageEnglish (US)
Pages (from-to)834-844
Number of pages11
JournalEuropean Urology
Issue number6
StatePublished - Jun 2018


  • Abiraterone
  • Androgen deprivation therapy
  • Docetaxel
  • Hormone-naïve
  • Locally advanced prostate cancer
  • Metastatic prostate cancer

ASJC Scopus subject areas

  • Urology


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