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Androgen Receptor Targeted Agents for Castration Resistant Prostate Cancer: A Review of Clinical Effectiveness and Cost-Effectiveness

Last updated: June 6, 2019
Project Number: RC1127-000
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 varying treatment sequences of androgen receptor targeted agents in patients with castrate-resistant prostate cancer?
  2. What is the comparative cost-effectiveness of varying treatment sequences of androgen receptor targeted agents in patients with castrate-resistant prostate cancer?

Key Message

Based on a single well conducted randomized controlled trial, patients who failed on first-line treatment with enzalutamide, subsequent treatment with abiraterone had low response rates, and the combination of enzalutamide and abiraterone was not indicated, owing to observed adverse effects. Likewise, evidence from very low quality non-randomized studies suggests that treatment sequence of enzalutamide-to-abiraterone is less favorable than abiraterone-to- enzalutamide sequence. Also, from very low quality non-randomized studies, subsequent chemotherapy with taxanes appeared to be more effective than alternative second-line androgen receptor targeting agents in treatment of chemotherapy-naïve metastatic castrate-resistant prostate cancer patients who progressed on first-line androgen receptor targeting agents. Due to substantial limitations of the non-randomized studies, these findings should be considered as preliminary and hypothesis generating. No comparative cost-effectiveness studies were identified.