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@ARTICLE{Fazekas:301540,
author = {T. Fazekas and M. Miszczyk and A. Giesen and T. Kói and F.
Zattoni and L. Rodriguez-Sanchez and T. Yanagisawa and A.
Matsukawa and T. Szarvas$^*$ and P. Kryst and J. G. Rivas
and A. S. Merseburger and M. D. Santis and S. Joniau and A.
Briganti and G. Marra and P. Nyirády and G. Gandaglia and
S. F. Shariat and P. Rajwa},
collaboration = {E. P. C. W. Group},
title = {{A}ndrogen {R}eceptor {P}athway {I}nhibitor {M}onotherapy
in {P}rostate {C}ancer: {S}afety, {O}ncologic {O}utcomes,
and {Q}uality of {L}ife-{A} {S}ystematic {R}eview and
{M}eta-analysis.},
journal = {European urology focus},
volume = {nn},
issn = {2405-4569},
address = {Amsterdam},
publisher = {Elsevier},
reportid = {DKFZ-2025-01061},
pages = {nn},
year = {2025},
note = {epub},
abstract = {Androgen receptor pathway inhibitors (ARPIs) as monotherapy
are studied increasingly across prostate cancer disease
states. We aimed to evaluate the safety, oncologic efficacy,
and quality of life (QoL) of ARPI monotherapy as compared
with ARPI + androgen deprivation therapy (ADT) and ADT
alone.PubMed/Medline, Embase, and Cochrane/Central were
queried through June 2024 for clinical trials. The primary
outcomes were the rates of adverse events (AEs) presented as
risk ratios (RRs); the secondary outcomes included efficacy
and QoL.We synthesized data from 2015 men, retrieved from 17
studies. The incidence of any AEs was similar between
patients on ARPIs, ARPI + ADT (RR: 1.01, $95\%$ confidence
interval [CI]: 1-1.02, p = 0.08), and ADT (RR: 1.01, $95\%$
CI: 0.98-1.04, p = 0.3). The incidence of grade ≥3 AEs was
higher in patients on ARPI monotherapy than in those on ADT
(RR: 1.18, $95\%$ CI: 1.11-1.24, p < 0.01), driven mainly by
fatigue and cardiovascular toxicity. There was no
statistically significant difference in grade ≥3 AEs
between patients treated with ARPIs and ARPI + ADT (RR:
1.07, $95\%$ CI: 0.87-1.3, p = 0.4). ARPI monotherapy led to
a lower incidence of hot flushes (RR: 0.4, $95\%$ CI:
0.18-0.89, p = 0.03) but higher incidences of breast pain
(RR: 6.03, $95\%$ CI: 3.34-10.88, p < 0.01) and gynecomastia
(RR: 5.73, $95\%$ CI: 3.79-8.66, p < 0.01) than treatment
with ARPI + ADT. ARPIs demonstrated promising oncologic
efficacy for patients with biochemical recurrence, while
maintaining favorable overall and sexual QoL.ARPI
monotherapy results in overall similar toxicities for ARPI +
ADT and ADT alone. The specific AE pattern of each
combination can serve as a basis to tailor therapy to each
patient's needs and wishes.},
subtyp = {Review Article},
keywords = {Abiraterone (Other) / Androgen deprivation therapy (Other)
/ Androgens (Other) / Apalutamide (Other) / Darolutamide
(Other) / Enzalutamide (Other) / Testosterone (Other)},
cin = {ED01},
ddc = {610},
cid = {I:(DE-He78)ED01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40404535},
doi = {10.1016/j.euf.2025.05.006},
url = {https://inrepo02.dkfz.de/record/301540},
}