近期肿瘤学指南推荐对广泛的前列腺癌（PCa）患者进行BRCA1/2检测。此外，在使用阿比特龙、恩扎鲁胺或多西他赛前治疗的突变阳性转移性去势抵抗性前列腺癌（mCRPC）患者中，PARP抑制剂也是有效的。然而，针对BRCA1/2阳性mCRPC患者哪种标准治疗最有效的问题仍然没有答案。本次荟萃分析的目的是评估阿比特龙、恩扎鲁胺和多西他赛治疗BRCA1/2突变阳性mCRPC患者在PSA反应（PSA50）、无进展生存期（PFS）和总生存期（OS）方面的疗效。鉴于该主题没有介入性试验，因此我们利用比例和个体患者数据进行数据合成，以评估BRCA1/2阳性mCRPC患者。对于PSA50评估，我们汇总了具有95％信心区间（CI）的事件率，而对于时间至事件（PFS，OS）分析，我们使用了个体患者数据和随机效应Cox回归计算。本次荟萃分析共包括16个符合条件的研究，涉及348名BRCA1/2阳性mCRPC患者。在第一线治疗中，阿比特龙、恩扎鲁胺和多西他赛的反应率分别为52％（CI：25-79％）、64％（CI：43-80％）和55％（CI：36-73％）。个体患者数据分析显示，与阿比特龙治疗患者相比，恩扎鲁胺具有PFS（HR：0.47，CI：0.26-0.83，p = 0.010）但没有OS（HR：1.41，CI：0.82-2.42，p = 0.210）上的优势。我们的PSA50分析表明，这三种第一线治疗都能对BRCA1/2阳性mCRPC产生治疗效果；尽管如此，基于PSA50和PFS分析结果，BRCA阳性mCRPC患者可能更好地对恩扎鲁胺治疗做出反应。然而，基于分子标记驱动的介入性研究，直接比较这些药物是提供更高级别证据的关键。© 2022. 作者（们）。

Recent oncology guidelines recommend BRCA1/2 testing for a wide range of prostate cancer (PCa) patients. In addition, PARP inhibitors are available for mutation-positive metastatic castration-resistant PCa (mCRPC) patients following prior treatment with abiraterone, enzalutamide or docetaxel. However, the question of which of these standard treatments is the most effective for BRCA1/2 positive mCRPC patients remains to be answered. The aim of this meta-analysis was to assess the efficacy of abiraterone, enzalutamide and docetaxel in BRCA1/2 mutation-positive mCRPC patients in terms of PSA-response (PSA50), progression-free survival (PFS) and overall survival (OS).As no interventional trials are available on this topic, we performed the data synthesis of BRCA1/2 positive mCRPC patients by using both proportional and individual patient data. For PSA50 evaluation, we pooled event rates with 95% confidence intervals (CI), while for time-to-event (PFS, OS) analyses we used individual patient data with random effect Cox regression calculations.Our meta-analysis included 16 eligible studies with 348 BRCA1/2 positive mCRPC patients. In the first treatment line, response rates for abiraterone, enzalutamide and docetaxel were 52% (CI: 25-79%), 64% (CI: 43-80%) and 55% (CI: 36-73%), respectively. Analyses of individual patient data revealed a PFS (HR: 0.47, CI: 0.26-0.83, p = 0.010) but no OS (HR: 1.41, CI: 0.82-2.42, p = 0.210) benefit for enzalutamide compared to abiraterone-treated patients.Our PSA50 analyses revealed that all the three first-line treatments have therapeutic effect in BRCA1/2 positive mCRPC; although, based on the results of PSA50 and PFS analyses, BRCA positive mCRPC patients might better respond to enzalutamide treatment. However, molecular marker-driven interventional studies directly comparing these agents are crucial for providing higher-level evidence.© 2022. The Author(s).