A new systematic review and network meta-analysis has identified the most effective treatment options for patients with metastatic hormone-sensitive prostate cancer (mHSPC) who also have visceral disease,a subgroup known to face significantly worse outcomes. The study, which analyzed eight phase 3 randomized controlled trials, focused on how various systemic therapies impact overall survival in this high-risk population.

Visceral metastases, affecting organs such as the liver or lungs, are associated with more aggressive disease and reduced survival. Out of 7,944 patients included in the analysis, 1,189 had documented visceral involvement. The findings strongly support the use of intensified treatment regimens, especially triplet therapy combining androgen deprivation therapy (ADT), docetaxel, and darolutamide. This combination showed the most substantial overall survival benefit, with a hazard ratio of 0.42 (95% CI: 0.21–0.82), translating to a 58% reduction in the risk of death compared to standard approaches.

Doublet therapies also showed promise. The combinations of ADT with either docetaxel (HR = 0.53) or abiraterone (HR = 0.58) outperformed other regimens involving androgen receptor pathway inhibitors such as enzalutamide, apalutamide, or darolutamide. These results suggest that both chemotherapy and abiraterone remain valuable tools, especially for patients who may not tolerate or qualify for triplet regimens.

However, the study has limitations. The analysis did not use individual patient data, which restricts more detailed subgroup analyses. Moreover, it did not differentiate outcomes based on specific organ involvement within the category of visceral disease, a factor that could influence treatment response.

Despite these limitations, the clinical message is clear: for mHSPC patients with visceral metastases, triplet therapy including darolutamide offers the greatest chance for extended survival. In its absence, doublet therapies with either docetaxel or abiraterone are preferred over other ARPI-based options.

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