PARP抑制剂（PARPi）是转移性去势抵抗性前列腺癌（mCRPC）患者的标准治疗选择。一些临床试验显示将PARPi与其他抗癌药物联合使用具有潜力。因此，我们进行了系统综述和荟萃分析，全面评估PARPi在转移性前列腺癌患者中的疗效和安全性。我们于2023年3月22日在MEDLINE、Cochrane CENTRAL、EMBASE、CINAHL和Web of Science数据库中搜索了2期或3期临床试验。评估了纳入研究中的有效性（无进展生存期[PFS]、总生存期[OS]、PSA下降>50%[PSA50]和客观缓解率[ORR]）和安全性结果。共计纳入了17项临床试验（PARPi单药疗法[n = 7]、PARPi + 雄激素受体信号抑制剂[ARSI][n = 6]和PARPi + 免疫检查点抑制剂[ICI][n = 4]），进行了定量分析。PARPi单药疗法改善了具有BRCA1或BRCA2基因改变的mCRPC患者的影像学PFS和OS，但并未改善具有ATM基因改变的患者。与单药PARPi或PARPi + ICI相比，PARPi + ARSI治疗的参与者报道了更高比例的PSA50和ORR。虽然所有组别的高级别不良事件发生率相似，但与PARPi单药疗法相比，使用PARPi联合治疗的患者治疗中止率较高。PARPi的疗效在具有DNA损伤修复基因改变的mCRPC患者中不均匀，并且最佳患者选择仍是一个临床挑战。从此分析中并未发现这类药物的意外安全信号。 由Elsevier Ltd.发表。

PARP inhibitors (PARPi) are a standard-of-care (SoC) treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Several clinical trials have shown the potential of combining PARPi with other anticancer agents. Therefore, we conducted a systematic review and meta-analysis to comprehensively evaluate the efficacy and safety of PARPi in patients with metastatic prostate cancer.MEDLINE, Cochrane CENTRAL, EMBASE, CINAHL, and Web of Science were searched on March 22nd, 2023, for phase 2 or 3 clinical trials. Efficacy (progression-free survival [PFS], overall survival [OS], PSA decline >50% [PSA50], and objective response rate [ORR]) and safety outcomes were assessed in the included studies.Seventeen clinical trials (PARPi monotherapy [n = 7], PARPi + androgen-receptor signaling inhibitors [ARSI] [n = 6], and PARPi + immune checkpoint inhibitors [ICI] [n = 4]) were included in the quantitative analyses. PARPi monotherapy improved radiographic PFS and OS over SoC in mCRPC patients with alterations in BRCA1 or BRCA2 genes but not in those with alterations in the ATM gene. Higher rates of PSA50 and ORR were reported in participants treated with PARPi + ARSI than in single-agent PARPi or PARPi + ICI. Although the rate of high-grade adverse events was similar across all groups, treatment discontinuation was higher in patients treated with PARPi-based combinations than PARPi monotherapy.The efficacy of PARPi is not uniform across mCRPC patients with alterations in DNA damage repair genes, and optimal patient selection remains a clinical challenge. No unexpected safety signals for this class of agents emerged from this analysis.Published by Elsevier Ltd.