最近进行的两项随机对照试验表明，在转移性激素敏感性前列腺癌（mHSPC）中，三重疗法（雄激素受体靶向药 [ARAT] + 多西他赛 + 雄激素剥夺疗法 [ADT]）比双重疗法（多西他赛 + ADT）具有整体生存益处，扩大了治疗选择。在我们之前对三重疗法与双重疗法的角色进行的系统性回顾和网络荟萃分析中，我们专注于 ARAT + ADT，因为这是许多国家对 mHSPC 的实际标准治疗。然而，疾病体积分层的生存数据仅适用于一种三重疗法方案（PEACE-1）。针对第二种三重疗法方案（ARASENS）分层的生存数据现已可用，因此我们为低和高体积的mHSPC更新了荟萃分析。与先前的发现一致，ADT单独不再代表有效的mHSPC治疗选择。相似的考虑适用于多西他赛 + ADT的双重疗法。对于低体积mHSPC，与ADT相比，除ARAT + ADT之外的联合疗法的益处不大。对于高体积mHSPC，darolutamide + 多西他赛 + ADT排名第一（P分数为0.92），其次是abiraterone + 多西他赛 + ADT（P分数为0.85），然后是ARAT + ADT联合疗法。在高体积mHSPC中，只有darolutamide + 多西他赛 + ADT表现出卓越的整体生存益处（风险比0.76，95％置信区间为0.59-0.97），而（汇总的）ARAT + ADT，证实了三重疗法在（高体积）mHSPC中的重要性。患者总结：我们进行了更新的比较，针对仍对激素治疗有反应的转移性前列腺癌的双重和三重治疗选择。对于肿瘤体积较小的患者，添加第三种药物没有明显的生存益处。对于肿瘤体积较大的患者，最佳的生存益处是通过darolutamide + 多西他赛 + 雄激素剥夺疗法获得的。版权所有©2023年欧洲泌尿外科学会。发行者为Elsevier B.V.。保留所有权利。

Two randomized controlled trials recently demonstrated an overall survival benefit with triplet therapy (androgen receptor axis-targeted agent [ARAT] + docetaxel + androgen deprivation therapy [ADT]) over doublet therapy (docetaxel + ADT) in metastatic hormone-sensitive prostate cancer (mHSPC), broadening the treatment options. In our previous systematic review and network meta-analysis on the role of triplet versus doublet therapy, we focused on ARAT + ADT, as this is the actual standard of care in many countries for mHSPC. However, survival data by disease volume were only available for one triplet therapy regimen (PEACE-1). Survival data stratified by disease volume for a second triplet regimen (ARASENS) are now available, hence we updated our meta-analysis for low- and high-volume mHSPC. Consistent with previous findings, ADT alone no longer represents a valid treatment option for mHSPC. Similar considerations apply to doublet therapy with docetaxel + ADT. For low-volume mHSPC, in comparison to ADT, the benefit of combination therapies other than ARAT + ADT was not substantial. For high-volume mHSPC, darolutamide + docetaxel + ADT ranked first (P score 0.92), followed by abiraterone + docetaxel + ADT (P score 0.85) and then ARAT + ADT combination therapies. In high-volume mHSPC, only darolutamide + docetaxel + ADT demonstrated superior overall survival (hazard ratio 0.76, 95% confidence interval 0.59-0.97) versus (pooled) ARAT + ADT, confirming the importance of triplet therapy in (high-volume) mHSPC. PATIENT SUMMARY: We performed an updated comparison of double and triple therapy options for metastatic prostate cancer that still responds to hormone treatment. For patients with low-volume cancer, there was no significant survival benefit from addition of a third drug. For patients with high-volume cancer, the best survival was obtained with darolutamide + docetaxel + androgen deprivation therapy.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.