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Treatment Sequences of Androgen Receptor Targeted Agents for Patients with Prostate Cancer

Last updated: March 17, 2021
Project Number: RC1347-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of various treatment sequences of ARTAs in patients with prostate cancer?
  2. What is the comparative cost-effectiveness of various treatment sequences of ARTAs in patients with prostate cancer?

Key Message

No evidence was found on the treatment sequences of androgen receptortargeted agents in patients with castration-sensitive prostate cancer. Evidence from retrospective studies, including those within a systematic review, suggests that sequential treatment of abiraterone followed by enzalutamide is more favourable than enzalutamide followed by abiraterone in improving clinical outcomes such as response rate and progression-free survival, but not overall survival, in patients with castration-resistant prostate cancer. Evidence from a retrospective study suggests that docetaxel-containing treatment sequences with androgen receptortargeted agents may improve progression-free survival compared to sequential therapy with androgen receptortargeted agents alone in patients with castration-resistant prostate cancer. Evidence from a retrospective study did not reveal differences in clinical outcomes of patients with castration-resistant prostate cancer treated with sequential androgen receptortargeted agents with or without interposed chemotherapy or radium-223. These findings were in line with those observed in a 2019 CADTH report.1 However, the findings should be interpreted with caution due to low-quality evidence. No comparative cost-effectiveness studies were identified.