Immunotherapy and endothelin receptor antagonists for treatment of castration-resistant prostate cancer

Abstract

Recently, novel therapies of prostate cancer, such as immunotherapy, endothelin receptor antagonists, novel androgen receptor antagonist and novel taxanes, and others have been introduced into clinical practice. This study was performed to summarize these results of immunotherapy and endothelin receptor antagonists in the treatment of castration-resistant prostate cancer (CRPC) and derive a more precise estimation of their effect on future treatment. The PubMed database, references of published trials, and review articles were searched. Two reviewers independently extracted data of these trials. We used hazard ratios (HRs) to assess the effects on overall survival (OS), progression-free survival (PFS), or time to disease progression (TTP), and relative risk (RR) for the different types of toxicity. In addition, 95% confidence intervals (CIs) give a sense of the precision of the estimate. Nine randomized controlled trials were ultimately identified. The pooled HR showed that immunotherapy could prolong OS significantly in patients with CRPC compared to placebo (HR = 0.70, 95% CI: 0.58-0.83, p < 0.001). Endothelin receptor antagonists also had modest benefits (HR = 0.90, 95% CI: 0.82-1.00, p = 0.046). Nevertheless, there were no significant benefits from both therapies on PFS or TTP. In addition, immunotherapy led to more fatigue, pyrexia, chills, and endothelin receptor antagonists led to more peripheral edema, anemia, and dyspnea. Our article suggested that the very acceptable toxicity and improving OS in patients with CRPC made immunotherapy an attractive option for such patients. However, future studies with thoughtful clinical trial designs are warranted. What's new? Recently, a number of novel therapies for prostate cancer have been introduced into clinical practice. In this study, the authors analyzed the literature on castration-resistant prostate cancer (CRPC), in order to evaluate the efficacy of two of these therapies: immunotherapy and endothelin receptor antagonists. The study found that immunotherapy can significantly prolong overall survival (OS) in patients with CRPC, while endothelin receptor antagonists have more modest benefits. In light of additional findings that the toxicity and side-effects profile of immunotherapy is acceptable, the authors recommend it as an attractive option for these patients. © 2013 UICC.