Taxane-based chemotherapy with or without platinum agents in metastatic castration-resistant prostate cancer: A systematic review and meta-analysis.

Abstract

e17079 Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge in later-line settings following progression on standard taxane-based chemotherapy. The addition of platinum agents, particularly carboplatin, to taxane therapy may enhance treatment efficacy, though optimal combination strategies remain under investigation. Methods: We systematically searched major databases for studies comparing taxane chemotherapy with or without carboplatin in mCRPC. One phase I–II randomized trial, one retrospective cohort, and one prospective biomarker study from the United States (2019–2021) were included. Primary outcomes were overall survival and PSA response (≥50% decline). Random-effects models were used to pool odds ratios and hazard ratios with 95% confidence intervals, with heterogeneity assessed using I². Results: Three studies comprising 310 mCRPC patients (median age 68 years; male population) evaluated taxane therapy (25 mg/m² IV every 21 days for up to 10 cycles) with or without carboplatin, administered alongside mandatory prednisone. Treatment was primarily delivered in post-docetaxel or later-line settings, although chemotherapy-naive patients were permitted in the randomized trial. All patients had received prior androgen-deprivation therapy, with substantial exposure to next-generation hormonal agents. Performance status was not uniformly reported; however, patients generally had good baseline functional status (ECOG 0–1). Combination taxane-carboplatin therapy significantly improved PSA response rates ≥50% compared with taxane monotherapy (OR 2.45; 95% CI, 1.44–4.16; p = 0.0009; I² = 0%). No statistically significant difference in overall survival was observed between treatment groups (HR 0.58; 95% CI, 0.21–1.55; p = 0.28), with substantial heterogeneity across studies (I² = 79%). Hematologic toxicities were more frequent with combination therapy, including higher rates of grade ≥3 thrombocytopenia and neutropenia, while treatment discontinuation rates were inconsistently reported. Conclusions: In later-line mCRPC, adding carboplatin to taxane chemotherapy improves PSA response rates, indicating enhanced antitumor activity, but does not confer a significant overall survival benefit and increases hematologic toxicity. These findings support selective use in carefully chosen patients and underscore the need for larger randomized trials to define clinical benefit, optimal dosing, and predictive biomarkers.