经过研究发现，对乳腺癌基因1/2（BRCA）的突变进行检测已成为临床医生的一种新型决策工具。携带致病性BRCA突变的转移性去势抵抗前列腺癌（mCRPC）患者可从聚合酶（ADP-核糖）聚合酶抑制剂（PARPi）和铂类治疗中获益，而该突变对卡巴嗪单药和前列腺特异性膜抗原（PSMA）配合物疗法的敏感性影响目前尚不明确。为评估PARPi、铂类、卡巴嗪和PSMA配合物疗法在BRCA阳性mCRPC患者中的疗效，我们在2022年2月查询了数据库，并采用比例和单个患者数据进行数据综合。对于前列腺特异性抗原（PSA）反应率（从基线降低≥50% [PSA50]）的评估，我们通过合并事件率和95%置信区间（CI）进行了合并分析。单个患者数据进行的无进展（PFS）和总体生存（OS）分析使用混合效应Cox比例风险模型和单臂随机效应分析，得到了合并中位数结果。我们纳入了23项符合条件的研究，共有901例BRCA阳性mCRPC患者。PARPi和铂类的PSA50反应率分别为69%（CI：53-82%）和74%（CI：49-90%）。OS数据分析显示，PARPi和铂类治疗之间没有差异（风险比：0.86；CI：0.49-1.52；p = 0.6）。单臂OS和PFS分析显示不同PARPi之间存在相似性；被合并的PFS和OS中位数分别为9.7个月（CI：8.1-12.5）和17.4个月（CI：12.7-20.1）。我们的数据表明，不同PARPi在PFS和OS方面的疗效相似。此外，我们发现PARPi和铂类治疗在PSA50反应率和OS方面相当，这突出了铂类作为BRCA阳性mCRPC患者的一种有效治疗选择。然而，开展比较这些药物的前瞻性干预研究对于提供更高水平的证据是必要的。在本报告中，我们发现不同聚合酶抑制剂的疗效相似，而铂类则是BRCA阳性转移性去势抵抗前列腺癌患者的有效治疗选择。版权所有 © 2023 作者。由Elsevier发表，版权所有。

Testing for mutations in Breast Cancer Gene 1/2 (BRCA) has emerged as a novel decision-making tool for clinicians. Patients with metastatic castration-resistant prostate cancer (mCRPC) harboring pathogenic BRCA mutations can benefit from poly (ADP-ribose) polymerase inhibitor (PARPi) and platinum treatments, whereas the impact of the mutation on sensitivity to cabazitaxel and prostate-specific membrane antigen (PSMA)-ligand therapy is currently unknown.To assess the efficacy of PARPi, platinum, cabazitaxel, and PSMA-ligand therapies in BRCA-positive mCRPC.Databases were queried in February 2022. We performed data synthesis by using both proportional and individual patient data. For prostate-specific antigen (PSA) response rate (≥50% decrease from baseline [PSA50]) evaluation, we pooled event rates with 95% confidence intervals (CIs). Progression-free (PFS) and overall (OS) survival analyses with individual patient data were performed with the mixed-effect Cox proportional hazard model and single-arm random-effect analysis, providing pooled medians.We included 23 eligible studies with 901 BRCA-positive mCRPC patients. PSA50 response rates for PARPi and platinum were 69% (CI: 53-82%), and 74% (CI: 49-90%), respectively. Analyses of OS data showed no difference between PARPi and platinum treatments (hazard ratio: 0.86; CI: 0.49-1.52; p = 0.6). The single-arm OS and PFS analyses revealed similarities among different PARPis; pooled PFS and OS medians were 9.7 mo (CI: 8.1-12.5) and 17.4 mo (CI: 12.7-20.1), respectively.Our data revealed that different PARPis were similarly effective in terms of PFS and OS. Moreover, we found that PARPi and platinum therapy were comparable in terms of PSA50 response rate and OS, highlighting that platinum is a valid treatment option for BRCA-positive mCRPC patients. However, prospective interventional studies comparing these agents are essential to provide a higher level of evidence.In this report, we found that different poly (ADP-ribose) polymerase inhibitors had similar efficacy, and platinum was a valid treatment option in BRCA-positive metastatic castration-resistant prostate cancer patients.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.